Anästhesiologisches Management in der Alterstraumatologie

Coburn, Mark; Röhl, Anna Bettina; Knobe, Matthias; Stevanovic, Ana; Stoppe, Christian; Rossaint, Rolf

doi:10.1007/s00101-016-0136-9

Cited by 26 publications

(9 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Complications may lead to a prolonged hospital stay. Among these are wound healing disorders, postoperative bleeding (especially under oral anticoagulation therapy), pneumonia, bed confinement and delirium . From the maxillofacial perspective, good chewing function is essential to ensure normal nutrition, although occlusion is often less relevant for patients with removable dentures.…”

Section: Introductionmentioning

confidence: 99%

“…Among these are wound healing disorders, postoperative bleeding (especially under oral anticoagulation therapy), pneumonia, bed confinement and delirium. 17,18 From the maxillofacial perspective, good chewing function is essential to ensure normal nutrition, although occlusion is often less relevant for patients with removable dentures. However, due to good oral hygiene and caries prophylaxis, today's older patients more frequently have their own teeth.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Changing trends in epidemiology and management of facial trauma in a Swiss geriatric population

et al. 2019

View full text Add to dashboard Cite

Objective To assess the prevalence and surgical treatment of facial fractures in a Swiss population aged 65 and over. Background The knowledge of the characteristics of geriatric trauma may help to prevent injuries and better allocate clinical resources for the management of multimorbid patients. Material and methods This study retrospectively evaluated a cohort of 181 patients who presented at the Bern University Hospital in Switzerland from May 2012 to September 2016. Data on age, gender, aetiology and type of trauma, treatment and complications, co‐morbidities and associated injuries were obtained. Results Women were most frequently affected (55.2%). Mean age was 80 years. Zygomatic complex fractures were the most frequent type of fractures (37%), followed by isolated orbital fractures (27.6%). Falls were the most common cause of trauma (76.1%). Thirty‐five per cent of all patients were taking anticoagulation or platelet aggregation medication. Hospitalisation was required in 88.4%, whereby 92.3% of the patients underwent surgical treatment. Surgery had to be performed immediately in three cases to treat compression of the optic nerve. Median hospital length of stay was 4 days, with 68% of patients returning to a domestic environment and 32% being transferred to another institution for further treatment. Conclusion The most common cause of facial injuries is a fall while standing in a domestic environment. Midface fractures were the most common type of fractures.

show abstract

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Changing trends in epidemiology and management of facial trauma in a Swiss geriatric population

et al. 2019

View full text Add to dashboard Cite

show abstract

“… 2 7 9 10 The aforementioned is associated with approximately 33 500 deaths in Germany, annually. 5 The vast majority of patients with hip fracture (95%) arrive at hospital with at least one major comorbidity, 11 including hepatic and renal function, diabetes mellitus, dementia, delirium, coronary artery disease, heart failure and patient polypharmacy. These are all individually linked to an increase in postoperative complications and mortality.…”

Section: Introductionmentioning

confidence: 99%

“… 11 Additional risk factors such as residential status, functional and cognitive impairment prior to fracture, male gender, poor nutrition status and anaemia have been identified and are associated with increased mortality. 5 Serious cardiac and pulmonary complications (pneumonia, pulmonary embolism, cardiac arrest and myocardial infarction) appear most frequent. 7 Furthermore, the number of comorbidities negatively influences the psychological outcomes of elderly patients with hip fracture.…”

Section: Introductionmentioning

confidence: 99%

Improve hip fracture outcome in the elderly patient (iHOPE): a study protocol for a pragmatic, multicentre randomised controlled trial to test the efficacy of spinal versus general anaesthesia

et al. 2018

View full text Add to dashboard Cite

IntroductionHip fracture surgery is associated with high in-hospital and 30-day mortality rates and serious adverse patient outcomes. Evidence from randomised controlled trials regarding effectiveness of spinal versus general anaesthesia on patient-centred outcomes after hip fracture surgery is sparse.Methods and analysisThe iHOPE study is a pragmatic national, multicentre, randomised controlled, open-label clinical trial with a two-arm parallel group design. In total, 1032 patients with hip fracture (>65 years) will be randomised in an intended 1:1 allocation ratio to receive spinal anaesthesia (n=516) or general anaesthesia (n=516). Outcome assessment will occur in a blinded manner after hospital discharge and inhospital. The primary endpoint will be assessed by telephone interview and comprises the time to the first occurring event of the binary composite outcome of all-cause mortality or new-onset serious cardiac and pulmonary complications within 30 postoperative days. In-hospital secondary endpoints, assessed via in-person interviews and medical record review, include mortality, perioperative adverse events, delirium, satisfaction, walking independently, length of hospital stay and discharge destination. Telephone interviews will be performed for long-term endpoints (all-cause mortality, independence in walking, chronic pain, ability to return home cognitive function and overall health and disability) at postoperative day 30±3, 180±45 and 365±60.Ethics and disseminationiHOPE has been approved by the leading Ethics Committee of the Medical Faculty of the RWTH Aachen University on 14 March 2018 (EK 022/18). Approval from all other involved local Ethical Committees was subsequently requested and obtained. Study started in April 2018 with a total recruitment period of 24 months. iHOPE will be disseminated via presentations at national and international scientific meetings or conferences and publication in peer-reviewed international scientific journals.Trial registration numberDRKS00013644; Pre-results

show abstract

“…An acute hip fracture (AHF), the second most common orthopedic fracture type in Scandinavia (and other regions), represents a major trauma, affecting elderly, often frail, patients, with considerable risk for poor outcome. Mortality is high, 7‐11% at 30 days, 10‐20% at 90 days, 25‐40% at one year, and about 50% three years after surgery .…”

Section: Introductionmentioning

confidence: 99%

Dementia and CSF‐biomarkers for Alzheimer's disease predict mortality after acute hip fracture

Dutkiewicz

Zetterberg

Andréasson

et al. 2019

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Background: Mortality is high after an acute hip fracture (AHF) surgery. Are cognitive impairment and/or altered levels of Alzheimer's Disease (AD)-biomarkers in cerebrospinal fluid (CSF) predictors of mortality in AHF-patients, as retrospective studies indicate? Methods: Prospective single-center study including 373 AHF-patients, operated in spinal anesthesia. Cognitive status was evaluated by clinical dementia rating (CDR);CSF was analyzed for AD-biomarker concentrations (total tau (T-tau), phosphorylated tau (P-tau), amyloid beta ratio (Aβ42/Aβ40). CDR and biomarker levels were related to mortality up to one-year post-surgery, using univariate logistic regression analysis.Results: Survival analyses showed that mortality was associated to the degree of dementia. In the entire patient cohort 30-, 90-, and 365-day mortality rates were 7.2%, 15.5%, and 25.5%, respectively, but only 2.7%, 5.5%, and 12.6%, for cognitively intact vs 16.3%, 31.7%, and 42.3% for demented patients (OR = 2.2-2.8 [CI = 1.6-4.9]; P = .0001). High CSF T-tau (OR = 1.19 [CI = 1.05-1.33]; P = .004) and low Aβ42/ Aβ40-ratio (OR = 0.85 [CI = 0.74-0.97]; P = .017) were associated with increased 90-day mortality. Analysis of 4 subgroups (Cognitive impairment ± and Biomarkers ±) showed significant associations of dementia and CSF biomarker concentrations to mortality after an AHF. Even cognitively intact patients presenting with abnormal AD-biomarkers showed an increased 90-day mortality which, however, was statistically insignificant. Conclusions: Cognitive impairment and altered CSF biomarker concentrations indicative of AD pathology can predict increased mortality in patients with an AHF, and so probably even before clinical dementia diagnosis by early biomarker analysis; a notion that may have substantial clinical implications by improving perioperative treatment and postoperative rehabilitation.

show abstract

Anästhesiologisches Management in der Alterstraumatologie

Abstract: The level of evidence in the perioperative management of elderly trauma patients is poor; therefore, there is an urgent need for large prospective studies in order to define uniform standards and guidelines.

Cited by 26 publications

References 49 publications

Changing trends in epidemiology and management of facial trauma in a Swiss geriatric population

Changing trends in epidemiology and management of facial trauma in a Swiss geriatric population

Improve hip fracture outcome in the elderly patient (iHOPE): a study protocol for a pragmatic, multicentre randomised controlled trial to test the efficacy of spinal versus general anaesthesia

Dementia and CSF‐biomarkers for Alzheimer's disease predict mortality after acute hip fracture

Contact Info

Product

Resources

About