Postoperative Pressure Ulcers After Geriatric Hip Fracture Surgery Are Predicted by Defined Preoperative Comorbidities and Postoperative Complications

Galivanche, Anoop R.; Kebaish, Kareem J.; Adrados, Murillo; Ottesen, Taylor D.; Varthi, Arya G.; Rubin, Lee E.; Grauer, Jonathan N.

doi:10.5435/jaaos-d-19-00104

Cited by 41 publications

(71 citation statements)

References 26 publications

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“…According to several population-based cohort studies, increased platelet counts had a significant association with mortality, risk of cardiovascular disease, and dementia [ 24 – 26 ]. In patients with hip fracture, Galivanche et al [ 27 ] reported that high platelet counts were a risk factor for developing a post-operative pressure ulcer. On the other hand, total lymphocyte count (TLC) is considered to be a nutritional marker, and 62.6% of hip fracture patients were malnourished as defined by TLC blew 1500 cells per cubic millimeter [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

High platelet-to-lymphocyte ratio predicts poor survival of elderly patients with hip fracture

Wang¹,

Wang²,

Yang³

et al. 2020

International Orthopaedics (SICOT)

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Purpose The platelet-to-lymphocyte ratio (PLR) has been extensively studied in various diseases. However, the relationship between PLR and hip fracture remains unknown. The aim of this study was to evaluate whether PLR would be an independent prognostic factor in elderly hip fracture patients. Methods Between January 2014 and December 2018, a retrospective cohort study was conducted in a orthopaedic centre, China. A total of 460 hip fracture patients were included. PLR was calculated as the ratio of platelet to lymphocyte counts and divided into high PLR group (≥ 189) and low PLR group (< 189) by using the receiver operating characteristic (ROC) curve. The relationship between PLR and one year all-cause mortality rate was assessed by univariate and multivariate Cox proportional hazard models. Further subgroup analysis stratified by different clinical and biological characteristics was performed to make the results more accurate. Results After a median follow-up of 32.0 months (range, 12.0-75.4), 92 patients (mortality rate: 20.0%) died within one year. PLR was significantly higher in dead patients compared with alive patients (p < 0.05), and high PLR group also had a high mortality rate (32.21% vs. 14.15%, p < 0.001). After multivariate adjustment, high PLR remained an independent predictor for one year all-cause mortality (adjusted hazard ratio (HR) 1.56, 95% confidence interval (CI) 1.02-2.41, p = 0.041). Moreover, advanced age (HR 1.05, 95% CI 1.01-1.08), male (HR 1.62, 95% CI 1.06-2.45), CCI ≥ 2 (HR 2.83, 95% CI 1.64-4.89), conservative treatment (HR 5.94, 95% CI 3.71-9.73), low haemoglobin level (HR 1.02, 95% CI 1.01-1.04), and low albumin level (HR 1.07, 95% CI 1.02-1.13) were independent risk factors for survival. Furthermore, subgroup analysis results were consistent with the main findings in most stratified groups. Conclusion This study highlights that high PLR (≥ 189) is associated with increased one year all-cause mortality in elderly hip fracture patients. As PLR is a simple indicator that can be calculated from the blood routine test, it can be easily performed in usual clinical practice.

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Section: Discussionmentioning

confidence: 99%

High platelet-to-lymphocyte ratio predicts poor survival of elderly patients with hip fracture

Wang¹,

Wang²,

Yang³

et al. 2020

International Orthopaedics (SICOT)

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“…Previous studies showed associations between hypoalbuminemia with the development of infections including surgical site infection ( 37 ), sepsis ( 35 ), and the development of delirium ( 14 , 38 ). Galivanche et al ( 39 ) found that infectious diseases, including sepsis, pneumonia, and urinary tract infections, and delirium were risk factors for the development of pressure sores. Thus, the fact that HBR patients had more pressures raises the issue of the level of daily nursing care that the patients received over the course of rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Intensive Inpatient vs. Home-Based Rehabilitation After Hip Fracture in the Elderly Population

et al. 2020

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Background: As the population ages, the rate of hip fractures and the need for rehabilitation increases. Home-based rehabilitation (HBR) is an alternative to classic inpatient rehabilitation (IR), which is an expensive framework with non-negligible risks. Methods: A retrospective study of patients 65 years and above following surgery to repair a hip fracture who underwent HBR or IR between 2016 and 2019. The two rehabilitation frameworks were compared for rehabilitation outcome and factors predicting successful rehabilitation. The outcome was determined with the Montebello Rehabilitation Factor Score-Revised (MRFS-R). Results: Data were collected for 235 patients over 3 years. The mean age was 81.3 ± 8.0 and 172 (73.3%) were women. Of these, 138 underwent IR and 97 HBR. The HBR group had better family support and fewer lived alone. There were also differences in the type of fracture and surgery. The medical condition of the IR group was more complex, as reflected in a higher Charlson's comorbidity scores, higher rates for delirium and more infectious complications, a lower Norton score, lower serum hemoglobin, and albumin levels, and higher serum creatinine and urea levels. It also had a more significant functional decline after surgery and required a longer rehabilitation period. However, no difference was found in the rehabilitation outcomes between the two groups (MRFS-R ≥ 50). The independent predictors for rehabilitation in the IR group were serum albumin level, comorbidity, and cognitive state. There were no independent predictors in the HBR group. Conclusions: In this retrospective study, there was no significant difference in short-term rehabilitation outcomes between the HBR and IR groups event though the patients in the IR group were medically more complex. This result should be taken into account when planning rehabilitation services after hip fracture and tailoring rehabilitation frameworks to patients.

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“…In a study analysing data from spinal disc herniation repair and abdominal surgeries in 24 patients, 9 (36%) developed category 1/2 PUs 16 . Among a cohort of geriatric hip fracture repair patients, 457 of the 8871 subjects (5.2%) developed PUs 17 . In liver resection patients, 11 of 128 patients (8.6%) have been reported to develop category 1 PUs in surgeries longer than 2 hours 18 .…”

Section: Prevalence and Risk Factors For Intraoperatively Acquired Timentioning

confidence: 99%

“…16 Among a cohort of geriatric hip fracture repair patients, 457 of the 8871 subjects (5.2%) developed PUs. 17 In liver resection patients, 11 of 128 patients (8.6%) have been reported to develop category 1 PUs in surgeries longer than 2 hours. 18 The above-reported variation in prevalence rates reflects marked differences in biomechanical tissue conditions at the various surgical positions and use of different equipment such as OT pads and other positioning and restraining devices, as well as variable patient conditions, ages, and health status.…”

Section: Pressure Ulcers/injuriesmentioning

confidence: 99%

Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: A scoping review

Gefen

Creehan²,

Black

2020

International Wound Journal

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An optimal position of the patient during operation may require a compromise between the best position for surgical access and the position a patient and his or her tissues can tolerate without sustaining injury. This scoping review analysed the existing, contemporary evidence regarding surgical positioning‐related tissue damage risks, from both biomechanical and clinical perspectives, focusing on the challenges in preventing tissue damage in the constraining operating room environment, which does not allow repositioning and limits the use of dynamic or thick and soft support surfaces. Deep and multidisciplinary aetiological understanding is required for effective prevention of intraoperatively acquired tissue damage, primarily including pressure ulcers (injuries) and neural injuries. Lack of such understanding typically leads to misconceptions and increased risk to patients. This article therefore provides a comprehensive aetiological description concerning the types of potential tissue damage, vulnerable anatomical locations, the risk factors specific to the operative setting (eg, the effects of anaesthetics and instruments), the complex interactions between the tissue damage risk and the pathophysiology of the surgery itself (eg, the inflammatory response to the surgical incisions), risk assessments for surgical patients and their limitations, and available (including emerging) technologies for positioning. The present multidisciplinary and integrated approach, which holistically joins the bioengineering and clinical perspectives, is unique to this work and has not been taken before. Close collaboration between bioengineers and clinicians, such as demonstrated here, is required to revisit the design of operating tables, support surfaces for surgery, surgical instruments for patient stabilisation, and for surgical access. Each type of equipment and its combined use should be evaluated and improved where needed with regard to the two major threats to tissue health in the operative setting: pressure ulcers and neural damage.

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Postoperative Pressure Ulcers After Geriatric Hip Fracture Surgery Are Predicted by Defined Preoperative Comorbidities and Postoperative Complications

Cited by 41 publications

References 26 publications

High platelet-to-lymphocyte ratio predicts poor survival of elderly patients with hip fracture

High platelet-to-lymphocyte ratio predicts poor survival of elderly patients with hip fracture

Intensive Inpatient vs. Home-Based Rehabilitation After Hip Fracture in the Elderly Population

Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: A scoping review

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