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

Dutkiewicz, Robert; Zetterberg, Henrik; Andréasson, Ulf; Blennow, Kaj; Nellgård, Bengt

doi:10.1111/aas.13472

Cited by 23 publications

(20 citation statements)

References 40 publications

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“…After adjusting for differences between the cohorts, there was a substantially increased risk of death due to cardiovascular, pulmonary, cerebrovascular, and septic events in patients with dementia. The relationship between dementia and postoperative mortality has long been known by orthopedic surgeons [1][2][3][4]. In a meta-analysis by Rao et al from 2016, comparing hospital outcomes in all patients with and without dementia, the authors found that the relative risk of allcause mortality was 70% higher in patients with dementia.…”

Section: Discussionmentioning

confidence: 99%

“…Labeling the cause of death as dementia obscures this fact and lulls physicians into a false sense of security by promoting the reasoning 'there was nothing more we could have done'. Dementia is a risk factor that predicts mortality, not the end cause [2][3][4].…”

Section: Discussionmentioning

confidence: 99%

“…The association between dementia and an increased risk of mortality after hip fracture operations is strongly backed by scientific evidence in the field of orthopedic surgery [1][2][3][4]. The volume of hip fractures is projected to continue to grow globally due to an aging population [5].…”

Section: Introductionmentioning

confidence: 99%

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The mortality burden in patients with hip fractures and dementia

Ioannidis

Ismail

Forssten

et al. 2021

Eur J Trauma Emerg Surg

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Purpose Dementia is strongly associated with postoperative death in patients subjected to hip fracture surgery. Nevertheless, there is a distinct lack of research investigating the cause of postoperative mortality in patients with dementia. This study aims to investigate the distribution and the risk of cause-specific postoperative mortality in patients with dementia compared to the general hip fracture population. Methods All adults who underwent emergency hip fracture surgery in Sweden between 1/1/2008 and 31/12/2017 were considered for inclusion. Pathological, conservatively managed fractures, and reoperations were excluded. The database was retrieved by cross-referencing the Swedish National Quality Registry for Hip Fracture patients with the Swedish National Board of Health and Welfare quality registers. A Poisson regression model was used to determine the association between dementia and all-cause as well as cause-specific 30-day postoperative mortality. Results 134,915 cases met the inclusion criteria, of which 20% had dementia at the time of surgery. The adjusted risk of all-cause 30-day postoperative mortality was 67% higher in patients with dementia after hip fracture surgery compared to patients without dementia [adj. IRR (95% CI): 1.67 (1.60–1.75), p < 0.001]. The risk of cause-specific mortality was also higher in patients with dementia, with up to a sevenfold increase in the risk cerebrovascular mortality [adj. IRR (95% CI): 7.43 (4.99–11.07), p < 0.001]. Conclusions Hip fracture patients with dementia have a higher risk of death in the first 30 days postoperatively, with a substantially higher risk of mortality due to cardiovascular, respiratory, and cerebrovascular events, compared to patients without dementia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The mortality burden in patients with hip fractures and dementia

Ioannidis

Ismail

Forssten

et al. 2021

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

show abstract

“…Lastly, it was proven that dementia predicted one-year mortality for patients with hip fracture. 32 , 33 However, we could not enroll this variable due to the lack of quantitative assessment of preoperative cognitive impairment in the original medical record.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Peripheral Nerve Block and Spinal Anesthesia in Terms of Postoperative Mortality and Walking Ability in Elderly Hip Fracture Patients – A Retrospective, Propensity-Score Matched Study

Fu¹,

Li²,

Wang³

et al. 2021

CIA

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To compare the effects of peripheral nerve block (PNB) and spinal anesthesia (SA) on one-year mortality and walking ability of elderly hip fracture patients after hip arthroplasty. Methods: Patients ≥65 years who underwent unilateral hip arthroplasty due to femoral neck fracture, using either PNB or SA from 2014 to 2019, were included. Demographic data, comorbidities, and results of preoperative screening were retrospectively collected. Propensity score matching (PSM) was performed in a ratio of 1:1 for PNB and SA groups. The primary outcomes were 30-day, 90-day, and one-year mortality. Secondary outcomes included walking ability in the first postoperative year, major complications, length of stay, and the cost of hospitalization. Survival analysis was performed using Kaplan-Meier method. Results: Three hundred and sixteen patients were included, of whom 200 received SA and 116 received PNB. Eighty-nine patients in each group were matched after PSM. Patients in the PNB group showed significantly lower risks of death in 30 days (2.2% vs 10.1%, P=0.029) and 90 days (3.4% vs 12.4%, P=0.026) after hip arthroplasty, when compared to the SA group. There was no significant difference in one-year mortality, walking ability, major complications, and length of stay. Higher hospitalization cost was found in the PNB group (53,828.21 CNY vs 59,278.83 CNY, P=0.024). One-year accumulated survival rate was higher in the PNB group without reaching a significant level. Conclusion: PNB was related to lower 30-and 90-day mortality but higher hospitalization cost in elderly hip fracture patients after hip arthroplasty. However, the anesthesia types were not associated with one-year mortality, one-year walking ability, major complications, and length of stay.

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“…The primary objective of this study was to observe longitudinal post‐surgical changes to serum neuroprotein concentrations (NFL, tau, Abeta40, 17 Abeta42), in association with concurrent peroperative changes to regional cerebral oxy‐saturation, and to post‐operative cognitive function (by so‐called ISPOCD tests 18 ) which might arise from low cerebral perfusion states in the beach chair position. Therefore, shoulder surgery patients were targeted.…”

Section: Introductionmentioning

confidence: 99%

Serum‐neuroproteins, near‐infrared spectroscopy, and cognitive outcome after beach‐chair shoulder surgery: Observational cohort study analyses

Larsen

Kobborg

Shahim

et al. 2020

Acta Anaesthesiol Scand

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Background Cerebral hypoxia may occur during surgery but currently used cerebral oxygenation saturation (rSO2) monitors remain controversial with respect to improving clinical outcome. Novel neuroprotein biomarkers are potentially released into systemic circulation and combined with near‐infrared spectroscopy (NIRS) could clarify the presence of per‐operative cerebral hypoxia. We investigated changes to serum‐neuroprotein concentrations post‐surgically, paired with NIRS and cognitive outcome, in patients operated in the beach chair position (BCP). Methods A prospective cohort in 28 shoulder surgery patients placed in the BCP. Blood samples were collected before induction of anaesthesia, and 2 hours and 3‐5 days post‐operatively. We analysed blood levels of biomarkers including tau and neurofilament light (NFL). We post hoc assessed the cross‐wise relationship between biomarker levels and post‐surgical changes in cognitive function and intraoperatively monitored rSO2 from NIRS. Results Serum‐NFL decreased from 24.2 pg/mL to 21.5 (P = .02) 2 hours post‐operatively, then increased to 27.7 pg/mL on day 3‐5 (P = .03). Conversely, s‐tau increased from 0.77 pg/mL to 0.98 (2 h), then decreased to 0.81 on day 3‐5 (P = .08). In 14/28 patients, episodic rSO2 below 55% occurred, and the duration < 55% was correlated to change in s‐tau (P < .05). The cognitive function z‐score at 1 week and 3 mo. correlated to the change in tau (P = .01), but not to NFL. Conclusion Some biomarkers were significantly changed with surgery in the beach chair position. The change was at some points associated to post‐operative cognitive decline, and to intraoperative low rSO2. (237).

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

Cited by 23 publications

References 40 publications

The mortality burden in patients with hip fractures and dementia

The mortality burden in patients with hip fractures and dementia

Comparison of Peripheral Nerve Block and Spinal Anesthesia in Terms of Postoperative Mortality and Walking Ability in Elderly Hip Fracture Patients – A Retrospective, Propensity-Score Matched Study

Serum‐neuroproteins, near‐infrared spectroscopy, and cognitive outcome after beach‐chair shoulder surgery: Observational cohort study analyses

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