Mortality and cardiorespiratory complications in trochanteric femoral fractures: a ten year retrospective analysis

Carow, Juliane; Coburn, Mark; Kim, Bong-Sung; Bücking, Benjamin; Bliemel, Christopher; Bollheimer, Leo Cornelius; Werner, Cornelius J.; Bach, Jan-Philipp; Knobe, Matthias

doi:10.1007/s00264-017-3639-3

Cited by 42 publications

(27 citation statements)

References 40 publications

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“…A liberal blood transfusion may result in pro-inflammatory, immunomodulating, and prothrombotic effects [37], which could cause serious systemic complications, such as cardiovascular events. Carow J et al [38] reported that a liberal blood transfusion causes higher cardiorespiratory complications in patients with trochanteric femoral fractures. We believe that the prediction of Hb drop would be helpful when blood transfusion is being considered in such fragile patients.…”

Section: Discussionmentioning

confidence: 99%

Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study

Lin

Chien

Hung

et al. 2020

BMC Musculoskelet Disord

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Background: With an increase in the elderly population, the occurrence of hip fractures, femoral neck fractures, and intertrochanteric fractures (ITFs) is also increasing. It is important to establish effective perioperative methods that would help reduce the morbidity and mortality rates associated with ITFs. The purpose of this study was to determine the effects of ITFs according to the AO classification for perioperative hemoglobin drop. Methods: Seventy-six patients with ITFs classified as AO 31-A1 or A2 and fixated with intramedullary nails participated in this retrospective cohort study. Medical records of these patients were retrospectively reviewed from September 2016 to August 2018. The perioperative hemoglobin drop was chosen as the main outcome measure and calculated as the difference between pre-and postoperative hemoglobin levels. Multivariate linear regression analysis was performed and included the following variables: AO classification (A1.1-A2.1 [stable] vs. A2.2-A2.3 [unstable]), time interval between injury and surgery, age, body mass index, and the use of anticoagulants. Results: Among the 76 patients who met the inclusion criteria, a significantly higher hemoglobin drop was observed in the AO 31 A2.2-A2.3 (unstable) group than in the AO 31 A1.1-A2.1 (stable) group (p = 0.04). The multivariate analysis also showed a greater hemoglobin drop in the unstable group (p < 0.05). Conclusions: Patients with unstable ITFs exhibited a greater hemoglobin drop and a hidden blood loss was suspected around the fracture site. We believe that this should be taken into consideration when presurgical blood transfusion is being planned for patients with unstable ITFs, to reduce associated postoperative complications, especially in patients with severe anemia or high risk of mortality.

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Section: Discussionmentioning

confidence: 99%

Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study

Lin

Chien

Hung

et al. 2020

BMC Musculoskelet Disord

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“…A number of variables were collected based on literature and availability [6,8,10,11]. The following pre-operative baseline variables were collected upon admission to the ED: age, sex, Body Mass Index/ Quetelet index (BMI), living situation prior to admission (at home, at home with home care, institutional care facility, other), whether or not the patient was living with a partner, number of different comorbidities (as mentioned in admission form), number of different medications, whether patients had experienced a previous episode of delirium, cognitive impairment (as mentioned in the admittance form, either declined or not declined), use of oral anticoagulants (yes/no), hemoglobin-(mmol/L), creatinine-(µmol/L), C-reactive protein (mg/L) levels.…”

Section: Measurementsmentioning

confidence: 99%

“…Patients aged 85 years or above constitute the fastest growing age group and are at even higher risk for postoperative complications and death than the general geriatric population [4][5][6][7]. These geriatric fracture patients are a distinct age group with considerable risk of negative medical outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Many studies have been done that include these older patients, especially hip fracture patients. These studies have shown that age, male gender and comorbidity are important predictors of mortality, but few have specifically targeted the age group of patients aged 85 or above [6,8]. Most studies focus on hip fractures and not the general population of geriatric orthopaedic trauma patients [8].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of 30-day mortality in orthogeriatric fracture patients aged 85 years or above admitted from the emergency department

Schuijt

Bos

Smeeing

et al. 2019

Eur J Trauma Emerg Surg

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Purpose Orthogeriatric trauma patients are at risk for functional decline and mortality. It is important to identify high-risk patients in an early stage, to improve outcomes and make better informed treatment decisions. The aim of this study was to identify independent risk factors for 30-day mortality in patients aged 85 years or above admitted from the emergency department with a fracture. Methods All orthopaedic trauma patients 85 years or above admitted from the emergency department were included. After a 30-day follow-up, mortality was determined by consulting the patient records. Multivariable logistics regression analysis generated odd ratios for mortality risk factors. A subgroup analysis was performed for patients undergoing hip fracture surgery. Results The 30-day mortality in geriatric fracture patients admitted to the hospital was 12%. Risk factors for 30-day mortality were: increased age, male sex, decreased hemoglobin levels, living in an institutional care facility and a decreased BMI. For geriatric patients undergoing hip fracture surgery 30-day mortality was 11%. Independent risk factors for this group were: increased age, male sex, and a decreased BMI. Conclusion Orthopaedic trauma patients aged 85 years or above who are admitted to the hospital with a fracture are at high risk for mortality. This study identified older age, male sex, and decreased BMI as predictors of 30-day mortality in admitted geriatric fracture patients and in geriatric hip fracture patients undergoing surgery.

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“…It is recognised that such patients are a vulnerable group who suffer multiple medical co-morbidities, which impact on morbidity and mortality [2,3]. …”

Section: Introductionmentioning

confidence: 99%

Patients with Clinically Suspected but Unproven Hip Fractures, Who Require Cross-Sectional Imaging, Are Best Initially Admitted under Geriatrician-Led Care—A Retrospective Review

2018

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Patients with suspected hip fractures who require further imaging to confirm or disprove the diagnosis may be admitted to orthopaedic or medical departments. We aim to provide evidence regarding the appropriate admission pathway for such patients. This is a retrospective study of all suspected hip fracture patients receiving second-line imaging between 1 January 2015 to 30 June 2016 in one hospital trust. Information was gained from hospital records to determine indication and result of imaging, eventual diagnoses, length of stay, and inpatient mortality. During the study period, 126 patients underwent cross-sectional imaging for clinically suspected but unproven hip fractures. Of these, 27% were positive for hip fractures (n = 34, 3.2% of hip fracture admissions) whilst the remainder were negative. Of the patients without hip fractures, 50 (54%) had a concomitant medical discharge diagnosis. Thirty-one different diagnoses were found in this cohort. This research provides evidence for geriatrician-led admission of patients with suspected but unproven hip fracture, due to the frailty and medical requirements of this patient group.

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Mortality and cardiorespiratory complications in trochanteric femoral fractures: a ten year retrospective analysis

Cited by 42 publications

References 40 publications

Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study

Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study

Predictors of 30-day mortality in orthogeriatric fracture patients aged 85 years or above admitted from the emergency department

Patients with Clinically Suspected but Unproven Hip Fractures, Who Require Cross-Sectional Imaging, Are Best Initially Admitted under Geriatrician-Led Care—A Retrospective Review

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