Predictors of Prognosis for Elderly Patients with Poststroke Hemiplegia Experiencing Hip Fractures

Feng, Mingli; Zhang, Jian; Shen, Hui-Liang; Hu, Huaijian; Cao, Li

doi:10.1007/s11999-009-0835-5

Cited by 19 publications

(16 citation statements)

References 43 publications

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“…Number of co-morbidities was summed across eight conditions: osteoarthritis, coronary heart disease, congestive heart failure, stroke, dementia, diabetes, chronic obstructive pulmonary disease and peripheral vascular disease (16). The American Society of Anesthesiologists (ASA) rating of operative risk was used as a proxy for severity of health problems at hospital admission (17, 18). Number of post operative-complications was summed across twenty nine complications (e.g., pressure sores, infection, anemia).…”

Section: Methodsmentioning

confidence: 99%

The association between body mass index, weight loss and physical function in the year following a hip fracture

Reider

Hawkes

Hebel

et al. 2013

The Journal of nutrition, health and aging

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Objectives To determine whether body mass index (BMI) at the time of hospitalization or weight change in the period immediately following hospitalization predict physical function in the year after hip fracture. Design Prospective observational study. Setting Two hospitals in Baltimore, Maryland. Participants Female hip fracture patients age 65 years or older (N=136 for BMI analysis, N=41 for analysis of weight change). Measurements Body mass index was calculated based on weight and height from the medical chart. Weight change was based on DXA scans at 3 and 10 days post fracture. Physical function was assessed at 2, 6 and 12 months following fracture using the Lower Extremity Gain Scale (LEGS), walking speed and grip strength. Results LEGS score and walking speed did not differ across BMI tertiles. However, grip strength differed significantly across BMI tertiles (p=0.029), with underweight women having lower grip strength than normal weight women at all time points. Women experiencing the most weight loss (>4.8%) had significantly lower LEGS scores at all time points, slower walking speed at 6 months, and weaker grip strength at 12 months post-fracture relative to women with more modest weight loss. In adjusted models, overall differences in function and functional change across all time points were not significant. However, at 12 months post fracture, women with the most weight loss had an average grip strength 7.0kg lower than women with modest weight loss (p=0.030). Conclusions Adjustment for confounders accounts for much of the relationships between BMI and function and weight change and function in the year after fracture. However, weight loss is associated with weakness during hip fracture recovery. Weight loss during and immediately after hospitalization appears to identify women at risk of poor function and may represent an important target for future interventions.

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Section: Methodsmentioning

confidence: 99%

The association between body mass index, weight loss and physical function in the year following a hip fracture

Reider

Hawkes

Hebel

et al. 2013

The Journal of nutrition, health and aging

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“…For example, age at admission depends on the patient's residence 72 and sex, 73 with men and those admitted from long-term care tending to be older than women and those admitted from home. The presence of chronic conditions depends on the patient's sex 60,66,74,75 and residence, 76 with men and those admitted from long-term care typically presenting with more chronic conditions than women and those admitted from home, respectively. Fitness for surgery depends on the patient's sex, 44 residence, 75,77 and socioeconomic status, 78 with men, those admitted from long-term care, and those from lower socioeconomic groups more likely to require medical stabilization before surgery than women, those admitted from home, and those from higher socioeconomic groups, respectively.…”

Section: Mediating Factorsmentioning

confidence: 99%

“…Both sex and dependent living influence variation in time to surgery through fitness for surgery, 44,75,77 and also influence variation in postoperative in-hospital death through chronic conditions. 60,66,[74][75][76] Treatment era influences variation in time to surgery through access policy, prioritization, and resource availability, 3 and also influences variation in postoperative in-hospital death through discharge policy and hospital stay. 3 Figure 3 thus highlights in orange seven factors that produce variation in time to surgery and postoperative in-hospital death: age, sex, dependent living, fracture type, hospital type, surgery type, and treatment era.…”

Section: Mediating Factorsmentioning

confidence: 99%

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Mortality by Timing of Hip Fracture Surgery

Sobolev

Guy

2017

The Journal of Bone and Joint Surgery

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In hip fracture care, it is disputed whether mortality worsens when surgery is delayed. This knowledge gap matters when hospital managers seek to justify resource allocation for prioritizing access to one procedure over another. Uncertainty over the surgical timing-death association leads to either surgical prioritization without benefit or the underuse of expedited surgery when it could save lives. The discrepancy in previous findings results in part from differences between patients who happened to undergo surgery at different times. Such differences may produce the statistical association between surgical timing and death in the absence of a causal relationship. Previous observational studies attempted to adjust for structure, process, and patient factors that contribute to death, but not for relationships between structure and process factors, or between patient and process factors. In this article, we (1) summarize what is known about the factors that influence, directly or indirectly, both the timing of surgery and the occurrence of death; (2) construct a dependency graph of relationships among these factors based explicitly on the existing literature; (3) consider factors with a potential to induce covariation of time to surgery and the occurrence of death, directly or through the network of relationships, thereby explaining a putative surgical timing-death association; and (4) show how age, sex, dependent living, fracture type, hospital type, surgery type, and calendar period can influence both time to surgery and occurrence of death through chains of dependencies. We conclude by discussing how these results can inform the allocation of surgical capacity to prevent the avoidable adverse consequences of delaying hip fracture surgery.

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“…However, it remains undecided whether lower hemoglobin levels in older people are necessarily an indicator of underlying comorbidities, or just an aspect of natural aging [7]. A large number of research has been done to investigate the impact of different variables on recovery after hip fracture surgery [8][9][10]. The effect of perioperative anemia on surgical mortality and morbidity in hip fracture patients has also been addressed in literature [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Is anemia at admission related to short-term outcomes of elderly hip fracture patients?

Dubljanin-Raspopovic¹,

Marković-Denić

Nikolić

et al. 2011

Open Medicine

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AbstractHip fracture in elderly people is associated with high morbidity and mortality. Therefore, it is important to identify risk factors that potentially influence outcomes after hip surgery. The main purpose of this study was to evaluate the relationship of anemia at admission and short-term outcomes after hip fracture. We studied 343 community-dwelling patients who underwent surgery for hip fracture from March 2009 to March 2010. Functional mobility at discharge, postoperative complications, hospital length of stay and in-hospital mortality were analyzed in respect to presence and severity of anemia at admission. Anemia (defined as hemoglobin levels < 13.0 g/dl for men and < 12.0g/dl for women) was present in 185 (53.9%) patients, of whom 54 (29.2%) were severely anemic (defined as hemoglobin level 10.0g/dl or below). In multivariate analysis anemia was associated with age, gender (female), type of fracture (intertrochanteric) and American Society of Anesthesiologists (ASA) classification (3 or 4), while severity of anemia was associated with recovery of ambulatory ability at discharge. There was no difference in the incidence of postoperative complication, in-hospital mortality and length of hospital stay between the groups at discharge. Overall anemia at admission is an indicator of poor general health status. Ambulatory recovery in hip fracture patients is independently related to severity of anemia at admission.

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Predictors of Prognosis for Elderly Patients with Poststroke Hemiplegia Experiencing Hip Fractures

Abstract: Hip fracture is an

Cited by 19 publications

References 43 publications

The association between body mass index, weight loss and physical function in the year following a hip fracture

The association between body mass index, weight loss and physical function in the year following a hip fracture

Mortality by Timing of Hip Fracture Surgery

Is anemia at admission related to short-term outcomes of elderly hip fracture patients?

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