Impact of Number of Drug Types on Clinical Outcome in Patients with Acute Hip Fracture

Maki, Hiroki; Wakabayashi, Hidetaka; Nakamichi, Mariko; Momosaki, Ryo

doi:10.1007/s12603-019-1250-6

Cited by 10 publications

(8 citation statements)

References 26 publications

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“…Drugs are included in the health condition component and are related to body functions and structure, activities, and participation components [20]. Polypharmacy caused worse outcomes for patients in convalescent and postoperative rehabilitation [21, 22]. Therefore, we suggest that the number of drugs may be an important factor in the study.…”

Section: Data and Statistical Analysesmentioning

confidence: 99%

Four Hours Postoperative Mobilization is Feasible After Thoracoscopic Anatomical Pulmonary Resection

et al. 2020

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Background We aimed to analyze the feasibility and risk factors associated with early mobilization (EM) within 4 h after thoracoscopic lobectomy and segmentectomy. Methods This study retrospectively evaluated 214 consecutive patients who underwent thoracoscopic anatomical pulmonary resection using our EM protocol between October 2017 and February 2019. We compared the correlations of the patients’ characteristics including the total number of drugs and perioperative parameters such as air leak, and orthostatic hypotension (OH) between the EM (E group) and failed EM (F group) groups. Second, we evaluated risk factors for OH, which often causes critical complications. Results A total of 198 patients (92.5%: E group) completed the EM protocol, whereas 16 patients did not (7.5%: F group). The primary causes of failure were severe pain, air leak, postoperative nausea and vomiting, and OH (n = 1, 3, 8, and 4). Upon univariate analysis, air leakage, OH, and non‐hypertension were identified as risk factors for failed EM (all p <0.05). EM was associated with a shortened chest tube drainage period (p <0.01). Thirty patients (14%) experienced OH, and 20% of them failed EM. A total number of drugs ≥5 (p = 0.015) was an independent risk factor for OH. Operative and anesthetic variables were not associated with EM or OH. Conclusions The EM protocol was safe and useful for tubeless management. Surgeons should be advised to actively prevent air leak. Our EM protocol achieved a low frequency of OH in mobilization. Due to its versatility, our mobilization protocol may be promising, especially in patients without severe comorbidities. Clinical registration number: The study protocol was approved by the Review Board of Aichi Cancer Center (approval number: 2020‐1‐067).

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Section: Data and Statistical Analysesmentioning

confidence: 99%

Four Hours Postoperative Mobilization is Feasible After Thoracoscopic Anatomical Pulmonary Resection

et al. 2020

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“…The frequency of adverse drug reactions has been shown to increase when six or more drugs are prescribed, and the frequency of falls among outpatients increases when five or more drugs are prescribed. Maki et al investigated the effect of polypharmacy on the occurrence of hip fractures in patients who took five or more oral medications and reported that patients experienced longer hospital stays and had decreased Barthel Index (BI) efficiency, relative to those taking fewer drugs [12]. Potentially inappropriate medications (PIMs) are a major concern in geriatric care.…”

Section: Introductionmentioning

confidence: 99%

Relationship between potentially inappropriate medications and functional prognosis in elderly patients with distal radius fracture: a retrospective cohort study

et al. 2020

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Background: Potentially inappropriate medications (PIMs) are a major concern in geriatric care. PIMs increase the risk of falls in elderly patients. However, the relationship between PIMs, subsequent falls, and functional prognosis for distal radius fracture (DRF) remains unclear. The aim of this study was to examine the relationship between PIMs, activities of daily living, and subsequent falls in elderly DRF patients. Methods: The study included 253 patients aged ≥ 65 years who required surgical treatment for DRF. Clinical characteristics of patients obtained included age, sex, body mass index, number of medicines used at admission, number and type of PIMs used at admission, bone mineral density, use of drugs for osteoporosis, severity of comorbidities, nutritional status, Barthel Index (BI), length of hospital stay, subsequent falls, fracture type, and Mayo wrist score. Subjects were divided into two groups according to PIMs use and no use. Propensity score matching was used to assess patient characteristics and confirm factors affecting BI and subsequent falls. Results: One hundred seven patients (42.3%) were prescribed PIMs upon hospital admission. The mean BI gain was significantly lower in patients prescribed PIMs than in those who were not (p = 0.006), as was the rate of falls postsurgery (p = 0.009). Multivariate analysis of BI gain showed that PIMs affected BI gain (95% confidence interval [CI], − 1.589 to − 0.196, p = 0.012), and logistic regression analysis revealed that PIMs influenced subsequent falls (odds ratio, 0.108, 95% CI, 1.246 to 2.357, p < 0.001). Conclusions: PIM use hindered the improvement in activities of daily living and increased the incidence of subsequent falls in patients assessed. These results demonstrate the importance of appropriate drug control for patients with DRF.

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“…Polypharmacy is common in older patients because of the greater likelihood of comorbidities, such as malnutrition. Overuse of medication and malnutrition can have a negative impact on the ability to participate in a rehabilitation program 16 , 17 ) . BCPs can optimize nutrition and medication to make patients more suitable for rehabilitation and increase their effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Association between the number of board-certified physiatrists and volume of rehabilitation provided in Japan: an ecological study

et al. 2022

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Objectives: This study aimed to determine the relationship between the number of board-certified physiatrists and the amount of inpatient rehabilitation delivered. Materials and Methods: We analyzed open data from 2017 in the National Database of Health Insurance Claims and Specific Health Checkups of Japan and compared the volume of inpatient rehabilitation services between prefectures to examine regional disparities. We also examined the relationship between the volume of rehabilitation services provided and the number of board-certified physiatrists. Results: The population-adjusted number of inpatient rehabilitation units per prefecture ranged from a maximum of 659,951 to a minimum of 172,097, a disparity of 3.8-fold. The population-adjusted number of board-certified physiatrists was 4.8 in the highest region and 0.8 in the lowest region, a disparity of 5.8-fold. The population-adjusted number of board-certified physiatrists was significantly correlated with the population-adjusted total number of inpatient rehabilitation units (r=0.600, P <0.001). Correlations were between the number of board-certified physiatrists and the number of rehabilitation units in cerebrovascular and orthopedic services, but not in cardiovascular, respiratory, or oncology services. Conclusion: Large regional disparities manifested in the amount of inpatient rehabilitation provided in Japan. An association was found between the number of board-certified physiatrists and rehabilitation units delivered. It may be necessary to train more BCPs in regions with fewer units to eliminate these disparities.

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Impact of Number of Drug Types on Clinical Outcome in Patients with Acute Hip Fracture

Cited by 10 publications

References 26 publications

Four Hours Postoperative Mobilization is Feasible After Thoracoscopic Anatomical Pulmonary Resection

Four Hours Postoperative Mobilization is Feasible After Thoracoscopic Anatomical Pulmonary Resection

Relationship between potentially inappropriate medications and functional prognosis in elderly patients with distal radius fracture: a retrospective cohort study

Association between the number of board-certified physiatrists and volume of rehabilitation provided in Japan: an ecological study

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