Timing of Adverse Events Following Geriatric Hip Fracture Surgery: A Study of 19,873 Patients in the American College of Surgeons National Surgical Quality Improvement Program

Bohl, Daniel D.; Samuel, Andre M.; Webb, Matthew L.; Lukasiewicz, Adam M.; Ondeck, Nathaniel T.; Basques, Bryce A.; Anandasivam, Nidharshan S.; Grauer, Jonathan N.

doi:10.12788/ajo.2018.0080

Cited by 10 publications

(20 citation statements)

References 32 publications

(80 reference statements)

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“…This result postulates that the care of elderly patients following hip fracture is inherently complicated and that the risk of perioperative complications is probably only modestly modifiable by best medical practices, including optimising time from clinical presentation to surgery. 26 This leaves the question whether to intervene at an early stage or postpone the procedure so that it can be performed by a dedicated (hip) team. We found no correlation between time to surgery and mortality and therefore consider postponing the procedure a safe option if deemed necessary.…”

Section: Discussionmentioning

confidence: 99%

Tapered, fluted, modular, titanium stems in Vancouver B periprosthetic femoral fractures: an analysis of 87 consecutive revisions

et al. 2020

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Aims: One of the instruments in the orthopaedic surgeon’s armamentarium to face the challenges associated with periprosthetic fracture around the stem of a hip replacement is the tapered, fluted, modular, titanium (TFMT) stem. Our aim was to study its clinical and radiological outcomes. Patients and Methods: During the period 2010–2016 86 patients (55 females; median age 78.2 years; mean BMI 26.3 kg/m2; median ASA classification 2) underwent 87 revisions for a Vancouver B periprosthetic fracture using a Stryker Restoration Cone-Conical stem. Results: After a median follow-up of 2.9 years no stem had to be revised and no case of stem fracture was found. Dislocation was the most common complication and occurred in 18% of patients. Other major complications were deep infection ( n = 4), subsidence >5 mm ( n = 7), and nonunion ( n = 5). 3-month and 1-year mortality was 10% and 15% respectively and was strongly correlated with age, deep infection, and ASA classification. The median EQ-5D health state index at final follow-up was 0.78 and all patients were ambulatory. Conclusions: The complication most commonly encountered was dislocation and can likely be prevented by the use of large heads, adequate reduction and fixation of the trochanteric area and restoration of the native anatomy. Contrary to previous concerns, fracture and subsidence of these modular stems do not appear to be a significant problem in this geriatric population.

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Section: Discussionmentioning

confidence: 99%

Tapered, fluted, modular, titanium stems in Vancouver B periprosthetic femoral fractures: an analysis of 87 consecutive revisions

et al. 2020

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“…The complications after hip fractures have always been a focus subject, particularly the cardiacerebrovascular disease including postoperative stroke [6]. Indeed, there is a large proportion of overlapping factors between hip fracture and stroke, such as advanced age, comorbidity, impaired vision, weakened muscle strength, cognitive impairment, and susceptibility to falls, so the incidence of stroke after hip fracture is increased by several folds [7][8][9]. In addition, during acute therapy in patients with hip fracture, traumatic stress, perioperative use of medications, surgical intervention, iatrogenic trauma, and postoperative pathophysiological changes also increased the risk of stroke [6,10].…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk factors associated with postoperative stroke in the elderly patients undergoing hip fracture surgery

Zhu

Chen

et al. 2020

J Orthop Surg Res

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Objectives Stroke is one of the rare but devastating complications after hip fracture in the elderly. By far, there is still scarce data on postoperative stroke in elderly patients with hip fractures. Methods This was a retrospective study of prospectively collected data. Between October 2014 to December 2018, patients aged above 65 years who underwent operative treatment for hip fractures were included. Inpatient medical surveillance and scheduled telephone follow-up at 1, 3, 6, and 12 months after operation was conducted to identify who developed an incident stroke. Variables of interests were extracted from patients’ inpatient medical records. Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors associated with stroke. Results During the study period, a total of 3743 patients were included, among whom 56 were found to have a stroke after operation, representing an incidence of 1.5% (95% CI, 1.1 to 1.9%). The multivariate analyses showed that advanced age (1-year increment; OR, 1.32; 95% CI, 1.08 to 1.48), history of previous stroke (OR, 4.79; 95% CI, 1.86 to 6.56), ASA III and above (OR, 2.62; 95% CI, 1.27 to 3.68), long-term use of aspirin (OR, 3.63; 95% CI, 1.41 to 4.78), and elevated RDW level (each increment of 1%, OR, 1.21; 95% CI, 1.02 to 1.36) were independently associated with postoperative stroke. Conclusions Although most are not modifiable, these risk factors help in counseling patients regarding the risk of postoperative stroke, individual risk stratification, and targeted optimization of medical conditions and should be firmly kept in treating surgeon’s mind.

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“…27 The median postoperative day of diagnosis for pneumonia has been reported to be the fourth day following geriatric hip fracture surgery. 28 The risk of hip fracture increases with rising age and a high percentage of hip fractures occur in women. 29 Hip fractures are usually multifactorial in origin and reflect an increased tendency to fall, and loss of protective reflexes and muscle strength.…”

Section: Discussionmentioning

confidence: 99%

<p>Postoperative Physical Therapy to Prevent Hospital-acquired Pneumonia in Patients Over 80 Years Undergoing Hip Fracture Surgery—A Quasi-experimental Study</p>

Ståhl¹,

Westerdahl²

2020

CIA

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Background Hip fracture requiring surgical fixation is a common condition with high mortality and morbidity in the geriatric population. The patients are usually frail, and vulnerable to postoperative complications and delayed recovery. Few studies have investigated physical therapy methods to prevent hospital-acquired pneumonia (HAP) after hip fracture surgery. Objective To explore whether an intensified physical therapy regimen can prevent HAP and reduce hospital length of stay in patients aged 80 and older, following hip fracture surgery. Patients and Methods The inclusion criterion was patients aged 80 or older who had undergone hip fracture surgery at Örebro University Hospital, Sweden during eight months in 2015–2016 (the “physical therapy group”) (n=69). The study has a quasi-experimental design with a historical control group (n=64) who had received routine physical therapy treatment. The physical therapy group received intensified postoperative physical therapy treatment, which included daily supervised early mobilization and coached deep breathing exercises with positive expiratory pressure (PEP). The patients were instructed to take deep breaths, and then exhale through the PEP-valve in three sessions of 10 deep breaths, at least four times daily. Early mobilization to a sitting position and walking was advised as soon as possible after surgery. Results There was a significantly lower incidence of HAP in the physical therapy group; 2/69 (3%, 95%CI: 1– 10) compared to the historical control group 13/64 (20%, 95%CI: 12–32%) ( p =0.002). Patients in the physical therapy group had a significantly shorter length of stay than the control group (10.6±4 vs 13.4±9 days, p =0.022). Conclusion Intensified physical therapy treatment after hip fracture surgery may be of benefit to reduce the incidence of HAP in patients over 80 years; however, the results need to be confirmed in randomized controlled trials.

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Timing of Adverse Events Following Geriatric Hip Fracture Surgery: A Study of 19,873 Patients in the American College of Surgeons National Surgical Quality Improvement Program

Cited by 10 publications

References 32 publications

Tapered, fluted, modular, titanium stems in Vancouver B periprosthetic femoral fractures: an analysis of 87 consecutive revisions

Tapered, fluted, modular, titanium stems in Vancouver B periprosthetic femoral fractures: an analysis of 87 consecutive revisions

Incidence and risk factors associated with postoperative stroke in the elderly patients undergoing hip fracture surgery

<p>Postoperative Physical Therapy to Prevent Hospital-acquired Pneumonia in Patients Over 80 Years Undergoing Hip Fracture Surgery—A Quasi-experimental Study</p>

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