A comparison of treatment setting for elderly patients with hip fracture, is the geriatric ward superior to conventional orthopedic hospitalization?

Rutenberg, Tal Frenkel; Daglan, Efrat; Heller, Snir; Velkes, Steven

doi:10.1016/j.injury.2017.04.049

Cited by 13 publications

(15 citation statements)

References 20 publications

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“…11 of them were excluded from the full-length review as they did not report the outcome of interest while 5 articles were excluded because they were not observational studies. Six studies [9,10,11,12,13,14] were subsequently excluded because they did not use standard AKI definitions of Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE), Acute Kidney Injury Network (AKIN), and Kidney Disease: Improving Global Outcomes (KDIGO) classifications. Thus, 17 cohort studies [18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,37] comprising 24,158 patients undergoing THA were included into the meta-analysis of associated AKI incidence.…”

Section: Resultsmentioning

confidence: 99%

“…Total hip arthroplasty (THA) is one of the most consistently successful and cost-effective orthopedic procedures performed today. It is indicated in patients with severe hip pain from a variety of conditions and ultimately provides significant improved pain relief, functionality and quality of life [9,10,11,12,13,14,15]. The total number of THA performed across the world is growing rapidly with close to 522,800 surgeries in the United States alone in 2014, making it the fourth most common operative procedure [16,17].…”

Section: Introductionmentioning

confidence: 99%

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Acute Kidney Injury in Patients Undergoing Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Thongprayoon

Kaewput

Thamcharoen

et al. 2019

JCM

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Background: The number of total hip arthroplasties (THA) performed across the world is growing rapidly. We performed this meta-analysis to evaluate the incidence of acute kidney injury (AKI) in patients undergoing THA. Methods: A literature search was performed using MEDLINE, EMBASE and Cochrane Database from inception until July 2018 to identify studies assessing the incidence of AKI (using standard AKI definitions of RIFLE, AKIN, and KDIGO classifications) in patients undergoing THA. We applied a random-effects model to estimate the incidence of AKI. The protocol for this meta-analysis is registered with PROSPERO (no. CRD42018101928). Results: Seventeen cohort studies with a total of 24,158 patients undergoing THA were enrolled. Overall, the pooled estimated incidence rates of AKI and severe AKI requiring dialysis following THA were 6.3% (95% CI: 3.8%–10.2%) and 0.5% (95% CI: 0.1%–2.3%). Subgroup analysis based on the countries by continent was performed and demonstrated the pooled estimated incidence of AKI following THA of 9.2% (95% CI: 5.6%–14.8%) in Asia, 8.1% (95% CI: 4.9%–13.2%) in Australia, 7.4% (95% CI: 3.2%–16.3%) in Europe, and 2.8% (95% CI: 1.2%–17.0%) in North America. Meta-regression of all included studies showed significant negative correlation between incidence of AKI following THA and study year (slope = −0.37, p <0.001). There was no publication bias as assessed by the funnel plot and Egger’s regression asymmetry test with p = 0.13 for the incidence of AKI in patients undergoing THA. Conclusion: The overall estimated incidence rates of AKI and severe AKI requiring dialysis in patients undergoing THA are 6.3% and 0.5%, respectively. There has been potential improvement in AKI incidence for patients undergoing THA over time.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury in Patients Undergoing Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Thongprayoon

Kaewput

Thamcharoen

et al. 2019

JCM

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“…Of the 37 included studies, only ten studies were RCTs [16][17][18][19][20][21][22][23][24][25]. Six studies were prospective cohort studies [26][27][28][29][30][31], ten were prospective cohort studies with a retrospective control [32][33][34][35][36][37][38][39][40][41], ten were retrospective cohort studies [42][43][44][45][46][47][48][49][50][51], and one study was a prospective pre-and post-intervention study [52]. Results of the Cochrane collaboration's tool for assessing risk of bias are given in Table 2.…”

Section: Risk Of Bias In the Included Studiesmentioning

confidence: 99%

“…The effect of orthogeriatric care on TTS was examined in a meta-analysis. Out of the 19 studies that had data on TTS, 13 were included in the meta-analysis [21,23,25,32,34,35,39,[43][44][45][46][47]51] (Fig. 3), while six were not because the data did not fulfill the requirements for the meta-analysis [22,24,30,33,38,42].…”

Section: Time To Surgery (Tts)mentioning

confidence: 99%

Effects of Orthogeriatric Care Models on Outcomes of Hip Fracture Patients: A Systematic Review and Meta-Analysis

Heghe

Mordant²,

Dupont

et al. 2021

Calcif Tissue Int

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Orthogeriatrics is increasingly recommended in the care of hip fracture patients, although evidence for this model is conflicting or at least limited. Furthermore, there is no conclusive evidence on which model [geriatric medicine consultant service (GCS), geriatric medical ward with orthopedic surgeon consultant service (GW), integrated care model (ICM)] is superior. The review summarizes the effect of orthogeriatric care for hip fracture patients on length of stay (LOS), time to surgery (TTS), in-hospital mortality, 1-year mortality, 30-day readmission rate, functional outcome, complication rate, and cost. Two independent reviewers retrieved randomized controlled trials, controlled observational studies, and pre/post analyses. Random-effects meta-analysis was performed. Thirty-seven studies were included, totaling 37.294 patients. Orthogeriatric care significantly reduced LOS [mean difference (MD) − 1.55 days, 95% confidence interval (CI) (− 2.53; − 0.57)], but heterogeneity warrants caution in interpreting this finding. Orthogeriatrics also resulted in a 28% lower risk of in-hospital mortality [95%CI (0.56; 0.92)], a 14% lower risk of 1-year mortality [95%CI (0.76; 0.97)], and a 19% lower risk of delirium [95%CI (0.71; 0.92)]. No significant effect was observed on TTS and 30-day readmission rate. No consistent effect was found on functional outcome. Numerically lower numbers of complications were observed in orthogeriatric care, yet some complications occurred more frequently in GW and ICM. Limited data suggest orthogeriatrics is cost-effective. There is moderate quality evidence that orthogeriatrics reduces LOS, in-hospital mortality, 1-year mortality, and delirium of hip fracture patients and may reduce complications and cost, while the effect on functional outcome is inconsistent. There is currently insufficient evidence to recommend one or the other type of orthogeriatric care model.

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“…[6] Co-management of hip fracture patients by orthopedic surgeons and geriatricians is suggested to be effective to reduce length of hospital stay without negatively affecting major patient outcomes. [7,8] On this account, multidisciplinary cooperation could be effective as conducted in Toyama Municipal Hospital. On the other hand, not only the operative delay but also postoperative morbidity has been crucial for prognosis of patients with orthopedic trauma.…”

Section: Introductionmentioning

confidence: 99%

Urinary retention as a postoperative complication associated with functional decline in elderly female patients with femoral neck and trochanteric fractures

et al. 2019

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Urinary retention (UR) has been recognized as one of the most common postoperative complications after hip surgery in elderly. The objective of the present study was to evaluate risk for postoperative complications of UR in elderly female patients with femoral neck fractures. We recruited 221 female patients (age 85.3 ± 7.0 years) with a history of hip surgery carried out at Toyama Municipal Hospital. UR occurred in 34 out of 221 cases (15.4%). Multiple logistic regression analysis was conducted to investigate the risk factors for UR, including age, body mass index (BMI), serum albumin, cognitive impairment, and activities of daily living (ADL). The results showed significant association of UR with cognitive impairment ( P = .005, odds ratio [OR] 4.11, 95% confidence interval [CI] 1.53–11.03), and ADL ( P = .029, OR 2.61, 95% CI 1.11–6.18), under adjustment with age and BMI. This study demonstrated that cognitive function and ADL were the important risk factors for UR, suggested that the postoperative management of UR is important with taking account of neurofunctional assistance and nursing care in daily living, especially in elderly female patients receiving surgery of femoral neck and trochanteric fractures.

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A comparison of treatment setting for elderly patients with hip fracture, is the geriatric ward superior to conventional orthopedic hospitalization?

Cited by 13 publications

References 20 publications

Acute Kidney Injury in Patients Undergoing Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Acute Kidney Injury in Patients Undergoing Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Effects of Orthogeriatric Care Models on Outcomes of Hip Fracture Patients: A Systematic Review and Meta-Analysis

Urinary retention as a postoperative complication associated with functional decline in elderly female patients with femoral neck and trochanteric fractures

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