Cognitive impairment influences the risk of reoperation after hip fracture surgery: results of 87,573 operations reported to the Norwegian Hip Fracture Register

Kristoffersen, Målfrid Holen; Dybvik, Eva; Steihaug, Ole Martin; Kristensen, Torbjørn Berge; Engesæter, Lars B.; Ranhoff, Anette Hylen; Gjertsen, Jan‐Erik

doi:10.1080/17453674.2019.1709712

Cited by 19 publications

(12 citation statements)

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“…Previous studies have reported 90-day mortality of 13% and one-year mortality of 23%. 2 The low mortality rate between four and 12 months could be an expression of selection bias, meaning that only the healthiest patients responded to the four-month questionnaire. This is also supported by the differences found in the baseline data between responders and non-responders at four months.…”

Section: Discussionmentioning

confidence: 99%

“…Hip fracture patients with chronic cognitive impairment (CCI) represent up to 37% of the hip fracture population, 1 and are often vulnerable. 2 Patients with CCI are often excluded from studies because of the difficulty in obtaining informed consent from patients or proxies. Excluding these patients can lead to systematic bias in existing knowledge of hip fracture patients.…”

Section: Introductionmentioning

confidence: 99%

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Patient-reported outcome measures after hip fracture in patients with chronic cognitive impairment

et al. 2021

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Aims Hip fracture patients have high morbidity and mortality. Patient-reported outcome measures (PROMs) assess the quality of care of patients with hip fracture, including those with chronic cognitive impairment (CCI). Our aim was to compare PROMs from hip fracture patients with and without CCI, using the Norwegian Hip Fracture Register (NHFR). Methods PROM questionnaires at four months (n = 34,675) and 12 months (n = 24,510) after a hip fracture reported from 2005 to 2018 were analyzed. Pre-injury score was reported in the four-month questionnaire. The questionnaires included the EuroQol five-dimension three-level (EQ-5D-3L) questionnaire, and information about who completed the questionnaire. Results Of the 34,675 included patients, 5,643 (16%) had CCI. Patients with CCI were older (85 years vs 81 years) (p < 0.001), and had a higher American Society of Anesthesiologists (ASA) classification compared to patients without CCI. CCI was unrelated to fracture type and treatment method. EQ-5D index scores were lower in patients with CCI after four months (0.37 vs 0.60; p < 0.001) and 12 months (0.39 vs 0.64; p < 0.001). Patients with CCI had lower scores for all dimensions of the EQ-5D-3L pre-fracture and at four and 12 months. Conclusion Patients with CCI reported lower health-related quality of life pre-fracture, at four and 12 months after the hip fracture. PROM data from hip fracture patients with CCI are valuable in the assessment of treatment. Patients with CCI should be included in future studies. Cite this article: Bone Jt Open 2021;2(7):454–465.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient-reported outcome measures after hip fracture in patients with chronic cognitive impairment

et al. 2021

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“…Total arthroplasty is more expensive, requires a longer surgery time, is more aggressive for the patient and with a higher probability of postoperative anemia and the need for transfusions. In addition, we should bear in mind that patients with dementia have a higher risk of prosthetic dislocation and periprosthetic fracture 14 . In our sample, only 176 patients with dementia underwent total arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Impacto de la demencia en la supervivencia de los pacientes con fractura de cadera intervenidos mediante prótesis total y parcial

Etxebarría-Foronda

Larrañaga

Ibarrondo

et al. 2021

Rev Osteoporos Metab Miner

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Objetive: To carry out a comparative survival analysis of patients diagnosed with hip fractures (HF) in the Basque Health Service from 2010 to 2016 depending on whether or not they were diagnosed with dementia and the type of arthroplasty. Material and methods:Observational study (real world data) of survival. The data were obtained from the administrative and clinical databases of the Basque Health Service using the Oracle Business Intelligence (OBI) manager. All cases of femur neck fractures from 2010 to 2016 were analyzed in the Basque Health Service. A descriptive analysis was carried out to detect differences between groups according to previous diagnosis of dementia and type of prosthesis. The Kaplan-Meier method was used to obtain the survival curves and their comparison was made in pairs using the Achievement test. The adjusted risk of death for each group was analyzed with the Cox regression model. Results: 5,867 patients with CF were identified, being 1,131 patients without dementia and total prosthesis, 3,073 without dementia and partial prosthesis, 176 with dementia and total prosthesis and 1,487 with dementia and partial prosthesis. The median survival was 9.08 years, 3.79 years, 2.55 years, and 2.54 years respectively. The comparison of the survival curves was significant for all cases except between the last two groups. Using the first group as a reference, the odds ratio of death for the rest was 1.56, 2.27 and 2.37 respectively. When analyzing the risk of death only for patients with dementia, the type of prosthesis was not statistically significant. Conclusions: Dementia influences the survival curve of patients who undergo arthroplasty after a femur neck fracture, with those who undergo a total arthroplasty have a similar mortality rate as those who undergo partial arthroplasty.

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“… 2016 , Kristoffersen et al. 2020 ) reported dementia to increase the risk of dislocation while others (Ninh et al. 2009 , Madanat et al.…”

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confidence: 99%

“…Several studies found no difference (Varley and Parker 2004, Enocson et al 2008, while Leonardsson et al (2012) showed increased risk of reoperation caused by dislocation with bipolar HA. For fracture patients, 2 studies (Li et al 2016, Kristoffersen et al 2020) reported dementia to increase the risk of dislocation while others (Ninh et al 2009, Madanat et al 2012, Abram and Murray 2015, Svenoy et al 2017 did not. Neurological disease (Li et al 2016) and dysplasia (Madanat et al 2012, Mukka et al 2015 are reported patient-related risk factors, whereas age, sex, and comorbidity do not seem to be associated with risk of dislocation (Enocson et al 2008, Madanat et al 2012, Abram and Murray 2015, Kim et al 2016, Mukka et al 2015, Svenoy et al 2017).…”

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Dislocation of hemiarthroplasty after hip fracture is common and the risk is increased with posterior approach: result from a national cohort of 25,678 individuals in the Swedish Hip Arthroplasty Register

et al. 2021

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Background and purpose — Reported revision rates due to dislocation after hemiarthroplasty span a wide range. Dislocations treated with closed reduction are rarely reported despite the fact that they can be expected to constitute most of the dislocations that occur. We aimed to describe the total dislocation rate on the national level, and to identify risk factors for dislocation. Patients and methods — We co-processed a national cohort of 25,678 patients in the Swedish Hip Arthroplasty Register, with the National Patient Register (NPR) and Statistics Sweden. Dislocation was defined as the occurrence of any ICD-10 or procedural code related to hip dislocation recorded in the NPR, with a minimum of 1-year-follow-up. In theory, all early dislocations should thereby be traced, including those treated with closed reduction only. Results — 366/13,769 (2.7%) patients operated on with direct lateral approach dislocated, compared with 850/11,834 (7.2%) of those with posterior approach. Posterior approach was the strongest risk factor for dislocation (OR = 2.7; 95% CI 2.3–3.1), followed by dementia (OR = 1.3; CI 1.1–1.5). The older the patients, the lower the risk of dislocation (OR = 0.98 per year of age; CI 0.98–1.0). Neither bipolar design nor cementless stems influenced the risk. Interpretation — The choice of posterior approach and dementia was associated with an increased dislocation risk. When hips treated with closed reduction were identified, the frequency of dislocation with use of direct lateral and posterior approach more than doubled and tripled, respectively, compared with when only revisions due to dislocation are measured.

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Cognitive impairment influences the risk of reoperation after hip fracture surgery: results of 87,573 operations reported to the Norwegian Hip Fracture Register

Cited by 19 publications

References 19 publications

Patient-reported outcome measures after hip fracture in patients with chronic cognitive impairment

Patient-reported outcome measures after hip fracture in patients with chronic cognitive impairment

Impacto de la demencia en la supervivencia de los pacientes con fractura de cadera intervenidos mediante prótesis total y parcial

Dislocation of hemiarthroplasty after hip fracture is common and the risk is increased with posterior approach: result from a national cohort of 25,678 individuals in the Swedish Hip Arthroplasty Register

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