scholarly journals Attributable Mortality of Hip Fracture in Older Patients: A Retrospective Observational Study

2020 ◽  
Vol 9 (8) ◽  
pp. 2370
Author(s):  
Lorène Zerah ◽  
David Hajage ◽  
Mathieu Raux ◽  
Judith Cohen-Bittan ◽  
Anthony Mézière ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Postoperative Complications ◽  
Mortality Rate ◽  
Observational Study ◽  
Older Patients ◽  
Final Analysis ◽  
Primary Objective ◽  
Retrospective Observational Study ◽  
Attributable Mortality ◽  
Baseline Characteristics

Hip fracture (HF) in older patients is associated with a high six-month mortality rate. Several clinical conditions may affect outcome, including baseline characteristics, co-existing acute illnesses, perioperative factors, and postoperative complications. Our primary objective was to estimate the respective effect of these four domains on six-month mortality after HF. A retrospective observational study using a monocentric cohort of older patients was conducted. All patients ≥ 70 years old admitted to the emergency department for HF and hospitalized in our perioperative geriatric care unit from June 2009 to September 2018 were included. Among 1015 included patients, five (0.5%) were lost to follow-up, and 1010 were retained in the final analysis (mean age 86 ± 6 years). The six-month mortality rate was 14.8%. The six-month attributable mortality estimates were as follows: baseline characteristics (including age, gender, comorbidities, autonomy, type of fracture): 62.4%; co-existing acute illnesses (including acute events present before surgery that could result from the fracture or cause it): 0% (not significantly associated with six-month mortality); perioperative factors (including blood transfusion and delayed surgery): 12.3%; severe postoperative complications: 11.9%. Baseline characteristics explained less than two-thirds of the six-month mortality after HF. Optimizing patients care by improving management of perioperative factors and thus decreasing postoperative complications, could reduce by a maximum of one quarter of the six-month mortality rate after HF.

scholarly journals Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP)

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Luigi Vetrugno ◽  
Enrico Boero ◽  
Elena Bignami ◽  
Andrea Cortegiani ◽  
Santi Maurizio Raineri ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Postoperative Complications ◽  
Observational Study ◽  
Elderly Patients ◽  
Fracture Fixation ◽  
Frail Elderly ◽  
Statistical Power ◽  
Lung Ultrasound ◽  
Preoperative Evaluation ◽  
Cardiac Complications

Abstract Background Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of “indirect” and “direct” cardiac and pulmonary lung ultrasound signs. Methods LUSHIP is an Italian multicenter prospective observational study. Patients will be recruited on a nation-wide scale in the 12 participating centers. Patients aged  >  65 years undergoing spinal anesthesia for hip fracture fixation will be enrolled. A lung ultrasound score (LUS) will be generated based on the examination of six areas of each lung and ascribing to each area one of the four recognized aeration patterns—each of which is assigned a subscore of 0, 1, 2, or 3. Thus, the total score will have the potential to range from a minimum of 0 to a maximum of 36. The association between 30-day postoperative complications of cardiac and/or pulmonary origin and the overall mortality will be studied. Considering the fact that cardiac complications in patients undergoing hip surgery occur in approx. 30% of cases, to achieve 80% statistical power, we will need a sample size of 877 patients considering a relative risk of 1.5. Conclusions Lung ultrasound (LU), as a tool within the anesthesiologist’s armamentarium, is becoming increasingly widespread, and its use in the preoperative setting is also starting to become more common. Should the study demonstrate the ability of LU to predict postoperative cardiac and pulmonary complications in hip fracture patients, a randomized clinical trial will be designed with the scope of improving patient outcome. Trial registration ClinicalTrials.gov, NCT04074876. Registered on August 30, 2019.

scholarly journals Clinical and Microbiological Characteristics of Visceral Leishmaniasis Outbreak in a Northern Italian Nonendemic Area: A Retrospective Observational Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
E. Franceschini ◽  
C. Puzzolante ◽  
M. Menozzi ◽  
L. Rossi ◽  
A. Bedini ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Observational Study ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Mediterranean Area ◽  
Retrospective Observational Study ◽  
Attributable Mortality ◽  
Microbiological Characteristics ◽  
The One ◽  
Bone Marrow Blood

Background. Visceral leishmaniasis (VL) caused byLeishmania infantumis endemic in the Mediterranean area. In the last decades a northward spread of the parasite has been observed in Italy. This paper describes a VL outbreak in Modena province (Emilia-Romagna, Northern Italy) between 2012 and 2015.Methods. Retrospective, observational study to evaluate epidemiological, microbiological characteristics, and clinical management of VL in patients referring to Policlinico Modena Hospital.Results. Sixteen cases of VL occurred in the study period. An immunosuppressive condition was present in 81.3%. Clinical presentation included anemia, fever, leukopenia, thrombocytopenia, and hepatosplenomegaly. Serology was positive in 73.3% of cases, peripheral blood PCR in 92.3%, and bone marrow blood PCR in 100%. Culture was positive in 3/6 cases (50%) and all the isolates were identified asL. infantumby ITS1/ITS2 sequencing. The median time between symptom onset and diagnosis was 22 days (range 6–131 days). All patients were treated with liposomal amphotericin b. 18.8% had a VL recurrence and were treated with miltefosine. Attributable mortality was 6.3%.Conclusions. VL due toL. infantumcould determine periodical outbreaks, as the one described; thus it is important to include VL in the differential diagnosis of fever of unknown origin, even in low-endemic areas.

scholarly journals The Occurrence of Seizure Clusters in Patients With Epilepsy Is Partly Determined by Epilepsy Severity: A Single-Center Retrospective Observational Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Rui Zhong ◽  
Qingling Chen ◽  
Xinyue Zhang ◽  
Weihong Lin
Keyword(s):  
Logistic Regression ◽  
Observational Study ◽  
Regression Models ◽  
Final Analysis ◽  
Retrospective Observational Study ◽  
Logistic Regression Models ◽  
History Of ◽  
Drug Resistant Epilepsy ◽  
The Individual ◽  
Patients With Epilepsy

Purpose: This retrospective observational study aimed to investigate the self-reported prevalence of seizure clusters (SCs) in patients with epilepsy (PWE) and its relationship with clinical characteristics.Methods: We retrospectively analyzed data from consecutive PWE from our hospital in northeastern China. Data were collected from the databank of a tertiary epilepsy center. Logistic regression models were employed to investigate the relationships between the individual patient demographic/clinical variables and the occurrence of SC.Results: In total, 606 consecutive PWE were included in the final analysis, and 268 (44.2%) patients experienced at least one seizure cluster. In multivariate logistic regression models, age (OR: 1.014; 95% CI: 1.002–1.027; p = 0.02), seizure frequency (OR: 2.08; 95% CI: 1.555–2.783; p < 0.001), multiple seizure types (OR: 5.111; 95% CI: 1.737–15.043; p = 0.003), number of current anti-seizure medications (ASM) (OR: 1.533; 95% CI: 1.15–2.042; p = 0.004), drug-resistant epilepsy (OR: 1.987; 95% CI: 1.159–3.407; p = 0.013), and a history of status epilepticus (OR: 1.903; 95% CI: 1.24–2.922; p = 0.003) were independent variables associated with a history of SC in PWE.Conclusion: Seizure clusters (SCs) are common occurrences at our study center. The occurrence of SC in individuals with epilepsy, to some extent, is determined by the epilepsy severity.

scholarly journals Factors influencing early and long-term survival following hip fracture among nonagenarians

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Laurence Weinberg ◽  
Bobby Ou Yang ◽  
Luka Cosic ◽  
Sarah Klink ◽  
Peter Le ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Postoperative Complications ◽  
Mortality Rate ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Term Survival ◽  
Hip Fracture Surgery ◽  
The Relationship ◽  
Fracture Surgery

Abstract Background The outcomes of nonagenarian patients undergoing orthopaedic surgery are not well understood. We investigated the 30-day mortality after surgical treatment of unilateral hip fracture. The relationship between postoperative complications and mortality was evaluated. Methods We performed a single-centre retrospective cohort study of nonagenarian patients undergoing hip fracture surgery over a 6-year period. Postoperative complications were graded according to the Clavien–Dindo classification. Correlation analyses were performed to evaluate the relationship between mortality and pre-specified mortality risk predictors. Survival analyses were assessed using Cox proportional hazards regression modelling. Results The study included 537 patients. The 30-day mortality rate was 7.4%. The mortality rate over a median follow-up period of 30 months was 18.2%. Postoperative complications were observed in 459 (85.5%) patients. Both the number and severity of complications were related to mortality (p < 0.001). Compared to patients who survived, deceased patients were more frail (p = 0.034), were at higher ASA risk (p = 0.010) and were more likely to have preoperative congestive heart failure (p < 0.001). The adjusted hazard ratio for mortality according to the number of complications was 1.3 (95% CI 1.1, 1.5; p = 0.003). Up to 21 days from admission, any increase in complication severity was associated significantly greater mortality [adjusted hazard ratio: 3.0 (95% CI 2.4, 3.6; p < 0.001)]. Conclusion In a nonagenarian cohort of patients undergoing hip fracture surgery, 30-day mortality was 7.4%, but 30-month mortality rates approached one in five patients. Postoperative complications were independently associated with a higher mortality, particularly when occurring early.

scholarly journals Epidemiological analysis of deaths and hospitalizations due to Alzheimer’s in Brazil from 2015 to 2019

2021 ◽  
Author(s):  
Gabriella Ribeiro de Almeida ◽  
Ana Júlia Omodei Rodrigues Martim ◽  
Ana Maria Bezerra Ramos ◽  
Anniele Eline Lima Menezes ◽  
Giovanna de Amorim Papaléo ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Observational Study ◽  
Health System ◽  
Cause Of Death ◽  
Mortality Rates ◽  
Progressive Increase ◽  
Retrospective Observational Study ◽  
Descriptive Data ◽  
Epidemiological Analysis ◽  
Unified Health System

Background: In 2050, Alzheimer’s disease (AD) may affect 14 million people worldwide, being considered the fourth leading cause of death in adults. Objectives: Analyze the variation in deaths, mortality rate and hospitalizations for AD from 2015 to 2019, in Brazil. Methods: We conducted a retrospective observational study of descriptive data from the Department of the Unified Health System (DATASUS). Results: In Brazil, from 2015 to 2019, there were 9045 hospitalizations and 1786 deaths from AD. Registering an increase in the total of dead about 75% (2015: n = 221; 2019: n = 386). In the years 2015-2019, the following mortality rates were recorded: 13.69; 14.86; 19.26; 21.23; 24,13, showing a smaller difference between the years 2015 and 2016 with 8.6%, and a greater difference between the deaths of 2016 and 2017 with 29%. Despite the growing trend of deaths from AD, there was a variation in the number of cases of hospitalizations in the analyzed period, with the following numbers per year, from 2015- 2019, respectively: 1,614; 1,501; 1,568; 1,550; 1,600, thus explaining that the year with the highest number of hospitalizations was 2015 (n = 1614), while the lowest was 2016 (n = 1501), showing a decrease between 2015-2019 of 0.86%. Conclusion: It was noted that 2019 had 165 more deaths than the year 2015 and a progressive increase in the mortality rate between 2015-2019. However, the number of hospitalizations during the study period was variable.

The impact of antithrombotic therapy on surgical delay and 2-year mortality in older patients with hip fracture: a prospective observational study

2020 ◽  
Vol 11 (4) ◽  
pp. 555-561 ◽  
Author(s):  
Samuel López ◽  
Carmen da Casa ◽  
Carmen Pablos-Hernández ◽  
David Pescador ◽  
Agustín Díaz-Álvarez ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Observational Study ◽  
Antithrombotic Therapy ◽  
Older Patients ◽  
Prospective Observational Study ◽  
Surgical Delay ◽  
The Impact

scholarly journals Pharmacist medication instructions are associated with continued medication self-management in older adults: a retrospective observational study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Eiji Kose ◽  
Hidetatsu Endo ◽  
Hiroko Hori ◽  
Shingo Hosono ◽  
Chiaki Kawamura ◽  
...  
Keyword(s):  
Older Adults ◽  
Observational Study ◽  
Demographic Data ◽  
Multiple Logistic Regression Analysis ◽  
Laboratory Data ◽  
Final Analysis ◽  
Functional Independence ◽  
Retrospective Observational Study ◽  
Self Management ◽  
Hospitalized Older Adults

Abstract Background Various factors are related to self-management of medication. However, few reports comprehensively examine the factors related to patients, medication levels, and other factors related to the recuperative environment, such as family support. The aim of this study was to investigate factors affecting the continuation of medication self-management among hospitalized older adults receiving convalescent rehabilitation. Methods We conducted a retrospective observational study with 274 consecutive patients newly admitted to the convalescent rehabilitation wards at a single hospital in Japan between January 2017 and May 2018. Participants who were assessed for their ability to take their medication using the Japanese Regimen Adherence Capacity Tests, were deemed to be self-manageable, and were able to successfully continue to self-manage their medication from admission to discharge were categorized as the “continuation group,” and those who were not able to continue were categorized as the “non-continuation group.” We analyzed the groups’ demographic data, laboratory data, and Functional Independence Measure. The primary outcome was the continuation of medication self-management from admission to discharge. Results After enrollment, 134 patients (median age 82 years; 62.7% women) were included in the final analysis. Some 60.4% of eligible patients were able to maintain medication self-management during their hospitalization. The multiple logistic regression analysis for the continuation of medication self-management during hospitalization after adjusting for confounding factors revealed that pharmacist medication instructions were independently and positively correlated with successful continuation of medication self-management (odds ratio: 1.378; 95% confidence interval 1.085–1.831; p = 0.0076). Conclusion Successful continuation of medication self-management is associated with pharmacist medication instructions among hospitalized older adults undergoing rehabilitation. Trail registration The Ethics Committee’s registration number is “TGE01216–066”.

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