Preventable risk factors of mortality after hip fracture surgery: Systematic review and meta-analysis

Chang, Wenli; Lv, Hongzhi; Chen, Feng; Yuwen, Peizhi; Wei, Ning; Chen, Wei; Zhang, Yingze

doi:10.1016/j.ijsu.2018.02.061

Cited by 105 publications

(83 citation statements)

References 37 publications

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“…This score enables a standardized risk assessment score for intra operative and post-operative risk 26,27 . A meta-analysis of Chang et al conducted in 2018, including 25,349 patients from16 studies (13 prospective and 3 retrospective), found a significant association between mortality after HF and several risk factors including cardiac disease, diabetes and cancer 14 . Charleston Comorbidity Index (CCI) was described as able to predict postoperative complications after HF surgery however the odds ratios were not very large 28 .…”

Section: Discussionmentioning

confidence: 99%

Risk factors and mortality of patients undergoing hip fracture surgery: a one-year follow-up study

Huette

Abou-Arab

Djebara

et al. 2020

Sci Rep

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Hip fracture (HF) remains a main issue in the elderly patient. About 1.6 million patients a year worldwide are victims of a Hf. their incidence is expected to rise with the aging of the world's population. identifying risk factors is mandatory in order to reduce mortality and morbidity. the aim of the study was to identify risk factors of 1-year mortality after HF surgery. We performed an observational, prospective, single-center study at Amiens University Hospital (Amiens, france). After ethical approval, we consecutively included all patients with a HF who underwent surgery between June 2016 and June 2017. Perioperative data were collected from medical charts and by interviews. Mortality rate at 12 months was recorded. Univariate analysis was performed and mortality risk factors were investigated using a Cox model. 309 patients were analyzed during this follow-up. Mortality at 1 year was 23.9%. Time to surgery over 48 hours involved 181 patients (58.6%) while 128 patients (41.4%) had surgery within the 48 hours following the hospital admission. Independent factors associated with 1-year mortality were: age (HR at 1.059 (95%CI [1.005-1.116], p = 0,032), Lee score ≥ 3 (HR at 1,52 (95% CI [1,052-2,198], p = 0.026) and time to surgery over 48 hours (HR of 1.057 (95% CI [1.007-1.108], p = 0.024). Age, delayed surgical (over 48 hours) management and medical history are important risk factors of 1-year mortality in this French cohort Hip fracture (HF) remains a main issue in the elderly patient. As bone loss tends to decreases in association with osteoporosis and osteopenia, the risk of hip fracture increases 1. HF represents a health care concern as the incidence and the mortality rate remains high 2,3. The world estimation of patients with HF is around 1.6 million a year 4. In France, 150 000 patients each year suffer HF. The mortality rate varies from 8 to 36% depending on the country 5-7. Only 50% patients will have independent living preservation following HF management 8. Recognized risk factors for HF are old age, reduced activity, female gender and osteoporosis. Though, in every day anesthesia practice, HF represents a surgery all practitioners have to deal with. However, data on perioperative management are lacking or rely on small sample size. Evidence is of low quality or even non-existent. Besides HF management mainly depends on each country healthcare system. Literature is abundant on national observational cohort 9,10. However, data are rarely comparable from one country to another depending on its healthcare system. Moreover, the management requires a multidisciplinary approach including geriatrician, surgeon and anesthetist. It seems that a care organization within a dedicated orthogeriatric ward can reduce long-term mortality 11-13. A recent meta-analysis revealed residential status, pulmonary disease, cardiovascular disease, diabetes, and time to surgery increased the risk of mortality after HF surgery 14. It also seems that surgery delay counts for the poor prognosis as reported in another meta-anal...

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Section: Discussionmentioning

confidence: 99%

Risk factors and mortality of patients undergoing hip fracture surgery: a one-year follow-up study

Huette

Abou-Arab

Djebara

et al. 2020

Sci Rep

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“…In previous studies that evaluated treatment outcomes including those for patients who received conservative treatment, the annual mortality rate ranged from 10% to 40% [10][11][12]. Factors reportedly associated with higher mortality included aging, male sex, cognitive dysfunction, cardiovascular disease, respiratory disease, diabetes mellitus, and malignant tumors [10][11][12][13][14][15]. The Charlson comorbidity index [12] and the American Society of Anesthesiologists Physical Status Classification System [13] are were also both reportedly associated with mortality.…”

Section: Discussionmentioning

confidence: 99%

“…About the timing of surgery, the National Institute for Health and Care Excellence recommends early surgery within 48 hours [4]; this strategy is associated with advantages such as reduced complications and improved functional recovery. Although early surgery is reported to be positively associated with the life prognosis [14], it is generally possible that a patient with no or few complications has undergone early surgery, and the effect of bias may be considered. In a Japanese study, 2010-2014 data showed that only 22.5% of patients underwent surgery within 2 days of hospitalization, and the risk of pneumonia and pressure ulcers was significantly reduced in the early surgery group [19].…”

Section: Discussionmentioning

confidence: 99%

Functional outcomes after the treatment of hip fracture

et al. 2020

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Osteoporotic hip fracture is a major public health issue. Estimation of the outcome and maximization of functional recovery after fracture is very important in the treatment of older patients. The purposes of this study were to clarify the functional outcomes after the treatment of hip fracture and to identify the factors that influence functional recovery. In the present study, 228 patients admitted to an acute-care hospital from January 2016 to June 2018 were evaluated. The patients were categorized into a trochanteric fracture group (n = 128) and a neck fracture group (n = 100). We retrospectively reviewed their ambulation ability 6 months after fracture using the Functional Ambulation Category (FAC) score. The other survey items were the presurgical duration, length of hospital stay, time until beginning to walk using parallel bars, complications affecting treatment, and mortality rate. The 6-month follow-up rate was 54.4% (n = 124). The results showed that the patients with trochanteric fracture were significantly older than those with neck fracture (86 vs. 82 years, respectively; p = 0.03). In total, 85.0% of patients with trochanteric fracture and 92.2% of patients with neck fracture were independent ambulators before injury (FAC score of 4 or 5). The FAC score 6 months after fracture was positively correlated with the FAC score before fracture and at discharge (all p<0.001) and negatively correlated with patient age (p<0.001) and presurgical duration for patients with neck fracture (p = 0.04). There was no statistically significant correlation with the length of hospital stay or the time until beginning to walk using parallel bars. In conclusion, patients with trochanteric fractures were older than those with neck fractures. In both fracture types, walking recovery 6 months after hip fracture was related to the FAC score before injury and at discharge from an acute-care hospital but not to the time until beginning to walk using parallel bars.

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“…BMI closest to date of surgery, within 1 year, was used for analysis. Diabetes mellitus was selected as an explanatory variable because of known associations with mortality in the setting of hip fractures (Chang et al, 2018; Meng et al, 2019) and altered analgesic requirements (Weiner et al, 2019). Smoking status was selected as an explanatory variable cause of known associations with complications in the setting of hip fractures (Ray, Aitken, McQueen, Court‐Brown, & Ralston, 2015) and altered analgesic requirements (Flanagan, Wysong, Ramey, & Vallier, 2018; Kuwabara et al, 2014; Walters, Cleck, Kuo, & Blendy, 2005).…”

Section: Methodsmentioning

confidence: 99%

Factors associated with discharge opioid prescription after hip fracture fixation

Fandino

Bhashyam

Harris

et al. 2020

Musculoskeletal Care

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Objective Opioid prescribing after hip fracture fixation is variable, but the factors that drive this prescribing variation are not well‐described. The purpose of this study was to determine independent factors associated with increased opioid prescription upon discharge after hip fracture fixation. Methods A retrospective cohort study of 296 adult patients who underwent hip fracture fixation between January 2016 and December 2017 at two Level I trauma centers were included in our study. The primary outcome measurement was opioid prescription at discharge in morphine milligram equivalents (MME). Bivariate analysis was used to screen for factors, and multivariable regression analysis was used to identify independent factors associated with opioid prescription upon discharge from the hospital. Results Discharge opioid prescription amounts were available for 280 out of 296 patients (95%). The mean (±standard deviation) discharge opioid prescription was 212 (±319) MME. Multivariable regression analysis showed that younger age (p = 0.004), diabetes mellitus (p = 0.02), smoking (p < 0.001), treatment at hospital #2 (p < 0.001), and weekend discharge (p = 0.03) were associated with increased opioid prescription at discharge. Conclusions Increased opioid prescribing after hip fracture fixation is associated with patient‐ and system‐related factors. Prescriber education programs, prescription guidelines, and safe handoff practices that focus on these factors may help to decrease prescription variability and opioid overprescription across institutions.

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Preventable risk factors of mortality after hip fracture surgery: Systematic review and meta-analysis

Cited by 105 publications

References 37 publications

Risk factors and mortality of patients undergoing hip fracture surgery: a one-year follow-up study

Risk factors and mortality of patients undergoing hip fracture surgery: a one-year follow-up study

Functional outcomes after the treatment of hip fracture

Factors associated with discharge opioid prescription after hip fracture fixation

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