scholarly journals Preadmission Statin Prescription and Inpatient Myocardial Infarction in Geriatric Hip Fracture

2021 ◽  
Vol 10 (11) ◽  
pp. 2441
Author(s):  
Seth M. Tarrant ◽  
Raymond G. Kim ◽  
Jack M. McDonogh ◽  
Matthew Clapham ◽  
Kerrin Palazzi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hip Fracture ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Inpatient Mortality ◽  
Hip Fracture Surgery ◽  
Statin Prescription ◽  
Geriatric Hip Fracture ◽  
Fracture Surgery ◽  
Statin Use

Statins have been shown to reduce myocardial infarction (MI) in cardiac and vascular surgery. MI is common in hip fracture. This study aims to investigate whether statins decrease MI in hip fracture surgery and reduce mortality resulting from MI. Patients aged 65 years and above with a low-energy hip fracture were identified between January 2015 and December 2017. Demographics, comorbidities, predictive scores, medications and outcomes were assessed retrospectively. The primary outcome was inpatient MI. The secondary outcome was inpatient mortality resulting from MI, for which fatal and non-fatal MI were modelled. Regression analysis was conducted with propensity score weighting. Hip fracture occurred in 1166 patients, of which 391 (34%) were actively taking statins. Thirty-one (2.7%) patients were clinically diagnosed with MI. They had a higher inpatient mortality than those who did not sustain an MI (35% vs. 5.3%, p < 0.0001). No reduction was seen between statin use and the occurrence of MI (OR = 0.97, 95% CI: 0.45–2.11; p = 0.942) including Fluvastatin-equivalent dosage (OR = 1.00, 95% CI: 0.96–1.03, p = 0.207). Statins were not associated with having a non-fatal MI (OR 1.47, 95% CI: 0.58-3.71; p = 0.416) or preventing fatal MI (OR = 0.40, 95% CI: 0.08–1.93; p = 0.255). Preadmission statin use and associations with clinically diagnosed inpatient MI or survival after inpatient MI were not able to be established.

scholarly journals Direct Oral Anticoagulants and Timing of Hip Fracture Surgery

2020 ◽  
Vol 9 (7) ◽  
pp. 2200
Author(s):  
Seth M. Tarrant ◽  
Michael J. Catanach ◽  
Mahsa Sarrami ◽  
Matthew Clapham ◽  
John Attia ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Primary Outcome ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Perioperative Outcomes ◽  
Surgical Timing ◽  
Serious Adverse Events ◽  
Hip Fracture Surgery ◽  
Geriatric Hip Fracture ◽  
Secondary Outcomes

Timely surgical intervention in hip fracture has been linked to improved outcomes. Direct Oral Anticoagulants (DOACs) are an emerging class of anticoagulants without evidence-based guidelines on surgical timing. This study aims to investigate how DOACs affect surgical timing and hence perioperative outcomes. A retrospective database/registry review was conducted for geriatric hip fracture patients aged 65 and over between 2011 and 2018. Primary outcome was 30-day mortality. Secondary outcomes included serious adverse events (SAE), transfusion and postoperative day (POD) 1 haemoglobin (Hb) levels. From a cohort of 3264 patients, 112 admitted subjects were taking DOACs; the annual proportion on DOACs increased over time. Mean time to surgery from last dose (Ts) was 2.2 (±1.0 SD) days. The primary outcome, 30-day mortality, occurred in 16 (14%) patients with secondary outcomes of SAEs in 25 (22%) patients and transfusion in 30 (27%) patients. Ts (days) did not significantly affect 30-day mortality (odds ratio (OR): 1.37, 95% confidence interval (CI): 0.80–2.33; p = 0.248), SAE (hazard ratio (HR): 1.03, 95% CI: 0.70–1.52; p = 0.885), transfusion (OR: 0.72 95% CI: 0.45 to 1.16; p = 0.177) or POD 1 Hb (OR: 1.99, 95% CI: −0.59 to 4.57; p = 0.129). Timing of surgery does not influence common surgical outcomes such as 30-day mortality, SAE, transfusion, and POD1 Hb in patients taking DOACs on admission.

scholarly journals Factors affecting the incidence of surgical site infection after geriatric hip fracture surgery: a retrospective multicenter study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Xiaopo Liu ◽  
Zhijie Dong ◽  
Jun Li ◽  
Yunbo Feng ◽  
Guolong Cao ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Surgical Site Infection ◽  
Multicenter Study ◽  
Geriatric Patients ◽  
Operating Time ◽  
Site Infection ◽  
Hip Fracture Surgery ◽  
Geriatric Hip Fracture ◽  
Fracture Surgery ◽  
Retrospective Multicenter Study

Abstract Background Geriatric hip fracture is a common type of osteoporotic fracture with high mortality and disability; surgical site infection (SSI) can be a devastating complication of this injury. By far, only a few studies identified easily remediable factors to reduce infection rates following hip fracture and less researches have focused on geriatric patients. The objective of this study was to identify potentially modifiable factors associated with SSI following geriatric hip fracture surgery. Methods This retrospective, multicenter study involves three level I hospitals. A total of 1240 patients (60 years or older) underwent hip surgery with complete data were recruited between January 2016 and June 2018. Demographics information, medications and additional comorbidities, operation-related variables, and laboratory indexes were extracted and analyzed. Receiver operating characteristic (ROC) analysis was performed to detect the optimum cut-off value for quantitative data. Univariate and multivariate logistic analysis model were performed respectively to identify the independent predictors. Results Ninety-four (7.58%) patients developed SSI in this study, and 76 (6.13%) had superficial infection, while 18 (1.45%) were diagnosed with deep infection. Results of univariate and multivariate analysis showed age > 79 years (OR, 2.60; p < 0.001), BMI > 26.6 kg/m2 (OR, 2.97; p < 0.001), operating time > 107 min (OR, 2.18; p = 0.001), and ALB < 41.6 g/L (OR, 2.01; p = 0.005) were associated with an increased incidence of SSI; drainage use (OR, 0.57; p = 0.007) could reduce the incidence of wound infection for patients after geriatric hip fracture. Conclusion Accurate modifiable variables, operating time > 107 min, serum albumin < 41.6 g/L, BMI > 26.6 kg/m2, and age > 79 years could be applied to distinguish geriatric patients with high-risk of postoperative surgical site infection.

scholarly journals RISK FACTORS FOR LONG-TERM MORTALITY IN VERY ELDERLY AFTER POST-OPERATIVE MYOCARDIAL INFARCTION FOLLOWING HIP FRACTURE SURGERY

2011 ◽  
Vol 57 (14) ◽  
pp. E1038 ◽  
Author(s):  
Bhanu P. Gupta ◽  
Lisa L. Kirkland ◽  
Jeanne M. Huddleston ◽  
Paul M. Huddleston ◽  
M Caroline Burton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Hip Fracture ◽  
Very Elderly ◽  
Hip Fracture Surgery ◽  
Fracture Surgery ◽  
Long Term Mortality

Blood transfusion rates and predictors following geriatric hip fracture surgery

2020 ◽  
pp. 112070001989787 ◽  
Author(s):  
Armin Arshi ◽  
Wilson C Lai ◽  
Brenda C Iglesias ◽  
Edward J McPherson ◽  
Erik N Zeegen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Blood Transfusion ◽  
Hip Fractures ◽  
Improvement Program ◽  
Hip Fracture Surgery ◽  
Femur Fractures ◽  
Postoperative Blood Transfusion ◽  
Geriatric Hip Fracture ◽  
Fracture Surgery

Background: Postoperative blood product transfusions in elderly hip fracture patients cause concern for morbidity and mortality. The purpose of this study was to identify predictors and short-term sequelae of postoperative transfusion following geriatric hip fracture surgery. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) to identify geriatric (⩾65 years) patients who sustained operative femoral neck, intertrochanteric, and subtrochanteric hip fractures in 2016. Multivariate regression was used to determine risk-adjusted odds ratios (OR) of associated perioperative risk factors and sequelae of postoperative transfusion. Results: In total, 8416 geriatric hip fracture patients were identified of whom 28.3% had documented postoperative transfusion. In multivariate analysis, age (OR 1.03 [1.02–1.04], p < 0.001), preoperative anaemia (OR 4.69 [3.99–5.52], p = 0.001), female sex (OR 1.61 [1.39–1.87], p < 0.001), lower BMI (OR 0.97 [0.96–0.98], p < 0.001), American Society of Anesthesiologists (ASA) classification (OR 1.14 [1.01–1.27], p = 0.031), COPD (OR 1.30 [1.06–1.59], p = 0.011), hypertension (OR 1.17 [1.01–1.35], p = 0.038), increased OR time (OR 1.02 [1.01–1.03], p < 0.001), and intertrochanteric (OR 2.99 [2.57–3.49], p < 0.001) and subtrochanteric femur fractures (OR 5.07 [3.84–6.69], p < 0.001) were independent risk factors for receiving postoperative blood transfusion. Patients with postoperative transfusion had a significantly higher risk-adjusted 30-day mortality (8.4% vs. 6.4%, OR 1.29 [1.02–1.64], p = 0.035), hospital readmission rate (9.4% vs. 7.7%, OR 1.27 [1.04–1.55], p = 0.018), and total hospital LOS (7.3 vs. 6.3 days, p < 0.001). Conclusions: Postoperative transfusion is a common occurrence in geriatric fragility hip fractures with multiple risk factors. Careful preoperative planning and multidisciplinary management efforts are warranted to reduce use of postoperative transfusions.

scholarly journals Comparative Effectiveness of Regional versus  General Anesthesia for Hip Fracture Surgery in Adults

2012 ◽  
Vol 117 (1) ◽  
pp. 72-92 ◽  
Author(s):  
Mark D. Neuman ◽  
Jeffrey H. Silber ◽  
Nabil M. Elkassabany ◽  
Justin M. Ludwig ◽  
Lee A. Fleisher
Keyword(s):  
Hip Fracture ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Odds Ratio ◽  
Cardiovascular Complications ◽  
Pulmonary Complications ◽  
Inpatient Mortality ◽  
Hip Fracture Surgery ◽  
Subgroup Analyses ◽  
Fracture Surgery

Background Hip fracture is a common, morbid, and costly event among older adults. Data are inconclusive as to whether epidural or spinal (regional) anesthesia improves outcomes after hip fracture surgery. Methods The authors examined a retrospective cohort of patients undergoing surgery for hip fracture in 126 hospitals in New York in 2007 and 2008. They tested the association of a record indicating receipt of regional versus general anesthesia with a primary outcome of inpatient mortality and with secondary outcomes of pulmonary and cardiovascular complications using hospital fixed-effects logistic regressions. Subgroup analyses tested the association of anesthesia type and outcomes according to fracture anatomy. Results Of 18,158 patients, 5,254 (29%) received regional anesthesia. In-hospital mortality occurred in 435 (2.4%). Unadjusted rates of mortality and cardiovascular complications did not differ by anesthesia type. Patients receiving regional anesthesia experienced fewer pulmonary complications (359 [6.8%] vs. 1,040 [8.1%], P &lt; 0.005). Regional anesthesia was associated with a lower adjusted odds of mortality (odds ratio: 0.710, 95% CI 0.541, 0.932, P = 0.014) and pulmonary complications (odds ratio: 0.752, 95% CI 0.637, 0.887, P &lt; 0.0001) relative to general anesthesia. In subgroup analyses, regional anesthesia was associated with improved survival and fewer pulmonary complications among patients with intertrochanteric fractures but not among patients with femoral neck fractures. Conclusions Regional anesthesia is associated with a lower odds of inpatient mortality and pulmonary complications among all hip fracture patients compared with general anesthesia; this finding may be driven by a trend toward improved outcomes with regional anesthesia among patients with intertrochanteric fractures.

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

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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