Orthogeriatric Service Reduces Mortality in Patients With Hip Fracture

Stenqvist, Charlotte; Madsen, Christian; Riis, Troels; Jørgensen, Henrik L.; Duus, Benn R; Lauritzen, Jes Bruun; Mark, Susanne van der

doi:10.1177/2151458515625296

Cited by 48 publications

(33 citation statements)

References 24 publications

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“…In order to improve outcomes following hip fracture surgery, it is imperative to identify modifiable factors that could possibly aid survival and function [ 23 ]. There have been promising results where an improved and close cooperation between orthopaedic surgeons and geriatricians have led to a reduction in mortality [ 24 ] aided by systematic and sustained quality improvement efforts [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Relative survival following hemi-and total hip arthroplasty for hip fractures in Sweden

Nemes

Lind

Cnudde

et al. 2018

BMC Musculoskelet Disord

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BackgroundHip fractures are a common problem in the ageing population. Hip arthroplasty is the common treatment option for displaced intracapsular neck of femur fractures. Even though hip replacements are successful in restoring mobility, reducing pain and diminishing loss of health-related quality of life, the potential impact of a hip fracture on life expectancy as well as the postoperative mortality need consideration. The purpose of this study was to describe the mid-term relative survival rate for a cohort of Swedish patients whom underwent total- or hemiarthroplasty surgery following hip fracture. We also explored whether the survival rate is prosthesis-type specific and influenced by comorbidities, sex, socioeconomic and surgical factors.MethodsUsing prospectively collected information of the Swedish Hip Arthroplasty Register-linked database we identified 43,891 patients operated between 2005 and 2012. Patient- and surgery-specific data in combination with socio-economic data were available for this analysis. We studied relative survival rate and used multivariable modelling with Cox Proportional Hazards Model in Transformed Time.ResultsCompared to the Swedish general population the baseline excess hazard was very high in the first half year after the operation, thereafter the excess hazard decreased but remained non-negligible through the 8 years’ follow-up period. The mortality rate of males was higher compared to women. Higher Elixhauser comorbidity index (ECI) was associated with worsening survival. However, patients who had ECI = 0 had higher mortality than patients with ECI =1 the first 420 days post fracture. Patients with a hemiarthroplasty had a worse survival than patients with a total hip arthroplasty. Of the hospital types considered university hospitals had lower survival rate. Younger patients had a greater loss of expected life span than patients who suffer hip fracture in their more advanced ages.ConclusionsSwedish hip fracture patients who undergo arthroplasty surgery had a high excess hazard of dying in the first half year following surgery, and this excess hazard never subsided to negligible levels at least up to 8 years after surgery. Interestingly having no prior record of illnesses worsened the initial mortality. Men living alone had the highest long-term excess mortality.

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Section: Discussionmentioning

confidence: 99%

Relative survival following hemi-and total hip arthroplasty for hip fractures in Sweden

Nemes

Lind

Cnudde

et al. 2018

BMC Musculoskelet Disord

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“…19 There is an urgent need for randomised controlled trials of treatment options and disease management in this frail group of patients. The use of CINPWT was a non-inferior treatment compared with stump bandage.…”

Section: Discussionmentioning

confidence: 99%

“…Major amputated patients have higher mortality rates at all points of time postoperatively than, for instance, hip fracture patients. 19 There is an urgent need for randomised controlled trials of treatment options and disease management in this frail group of patients.…”

Section: Discussionmentioning

confidence: 99%

Does closed incision negative wound pressure therapy in non‐traumatic major lower‐extremity amputations improve survival rates?

Stenqvist

Nielsen

Napolitano

et al. 2019

International Wound Journal

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Closed incision negative pressure wound therapy (CINPWT) has been shown to be clinically effective compared with the traditional gauze dressing, reducing surgical site infections and wound complications. We evaluated the effect of CINPWT compared with gauze dressing on the need for revision surgery and survival after non‐traumatic major lower amputation. We included 309 patients undergoing 403 major lower amputations in a retrospective study from January 1, 2010 to November 23, 2017. A total of 139 patients received CINPWT, and 170 patients received stump bandage. There was no statistically significant difference between the two groups regarding the need for revision surgery (P = .45). Fourteen stump bandage patients and 15 CINPWT patients died in hospital (P = .57). One year after amputation, 55 CINPWT patients and 66 stump bandage patients had died (P = .82). Survival probabilities adjusted for age and gender 2 years after amputation were .52 (.43‐.61) and .49 (.42‐.58), respectively, and 3 years after amputation were .36 (.25‐.50) and .39 (.32‐.47), respectively. We also found no significant difference in the need for revision surgery in survival probabilities up till 3 years after amputation between patients treated with CINPWT and patients treated with gauze bandage postoperatively.

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“…19 Even with integrated orthogeriatric care for hip fracture patients, the mortality rate remains high. Stenqvist et al reported that integrated orthogeriatric care decreased the inhospital mortality rate from 6.3% to 3.1%, 20 while Forni et al found that it reduced the 30-day mortality rate from 4.3% to 3.4%. 21 Furthermore, Folbert et al concluded that integrated orthogeriatric care lowered the 12-month mortality rate from 35.1% to 23.2%.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome and quality of life in patients with hip fracture after total knee arthroplasty

Koh

Chen

Yew

et al. 2019

J Orthop Surg (Hong Kong)

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Introduction: Hip fractures are a cause of significant morbidity. While rare, ipsilateral hip fractures within 12 months after total knee arthroplasty (TKA) can negatively affect the functional outcome and the quality of life for patients who have had TKA. This aim of this study is to investigate (1) the incidence of hip fracture within 12 months after TKA and (2) the influence of hip fracture after TKA on functional outcome and quality of life in patients. Methods: Between March 1999 and February 2012, 25 patients who sustained an ipsilateral hip fracture within 12 months after TKA were included in this study. A propensity score matching algorithm was used to select a 1:3 control group without hip fracture. All patients were assessed using the Oxford Knee Score (OKS), Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Physical Component Score (PCS) and Mental Component Score (MCS) of SF-36®. Results: The incidence of hip fracture was 0.16% among male patients and 0.20% for female patients. At 24 months after TKA, the OKS was 36 ± 7 in the hip fracture group versus 41 ± 5 in the control group (p = 0.003). The KSFS was 50 ± 24 in the hip fracture group versus 68 ± 21 in the control group (p = 0.001), while the KSKS was 83 ± 12 and 87 ± 8, respectively (p = 0.166). The PCS was 37 ± 12 in the hip fracture group versus 47 ± 11 in the control group (p < 0.001), while the MCS was 55 ± 10 and 54 ± 11, respectively (p = 0.664). Conclusion: Although hip fracture during the rehabilitation period after TKA is uncommon, these patients have poorer functional outcome and quality of life. We recommend additional caution against hip fracture after TKA.

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Orthogeriatric Service Reduces Mortality in Patients With Hip Fracture

Cited by 48 publications

References 24 publications

Relative survival following hemi-and total hip arthroplasty for hip fractures in Sweden

Relative survival following hemi-and total hip arthroplasty for hip fractures in Sweden

Does closed incision negative wound pressure therapy in non‐traumatic major lower‐extremity amputations improve survival rates?

Functional outcome and quality of life in patients with hip fracture after total knee arthroplasty

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