Upper gastrointestinal bleeding in neck of femur fracture patients: a single tertiary centre experience

Liu, Jessamine; Gupta, Rohit; Hay, Karen; Pullè, C; Rahman, Tony; Pandy, Shaun

doi:10.1111/imj.13809

Cited by 4 publications

(9 citation statements)

References 20 publications

(54 reference statements)

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“…In meta-analyses of studies that examined medication adherence and outcomes in type 2 diabetes (largely in middle-aged subjects), better adherence has been associated both with a lower rate of hospitalisation and lower all-cause mortality. 15,18 Our study's limitations include that it is retrospective and observational, and that we have not accounted for partial adherence in subjects taking more than one medication. It is possible that adherence to insulin treatment might be poorer than to oral medication, but we did not analyse this.…”

Section: Discussionmentioning

confidence: 99%

Adherence to medication, glycaemic control and hospital attendance in young adults with type 2 diabetes

Kunasegaran

Beig

Khanolkar

et al. 2018

Internal Medicine Journal

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Type 2 diabetes is becoming common among people in their 20s and 30s. Glycaemic control is suboptimal in this group and is associated with poor medication adherence. We studied medication adherence over a 24-month period in all diabetes clinic registrants (n = 266) between the ages of 18 and 39 years. We reviewed their glycaemic control using mean HbA1c over the study period and examined hospital records to determine the number of hospital attendances during this time. We found that less than half the group (47%) had good adherence (>90%) and 21% of the group had very poor adherence (<50%). Mean adherence was slightly poorer in women compared to men (73% vs 76%, P = 0.04). There was a marked inverse relationship between adherence and glycaemic control. Mean HbA1c is 70 mmol/mol among those with good adherence and mean HbA1c is 97 mmol/mol among those with very poor adherence (P < 0.05). Fifty-seven per cent of the study group had at least one hospital attendance during this time. Eighty-eight hospital attendances were due to a medical cause. Study of trend showed more medical admissions among those with very poor adherence (P = 0.03). Mean HbA1c was higher in those who required medical admissions (87 mmol/mol vs 75 mmol/mol) when compared to those with no hospital attendance. Our study shows that poor adherence is common and significantly related to glycaemic control as well as unplanned hospital attendances for medical conditions. Despite limitations, our study provides valuable information on medication adherence and its impact on glycaemic control and morbidity among young people with type 2 diabetes.

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Section: Discussionmentioning

confidence: 99%

Adherence to medication, glycaemic control and hospital attendance in young adults with type 2 diabetes

Kunasegaran

Beig

Khanolkar

et al. 2018

Internal Medicine Journal

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“…The reported incidence of perioperative acute upper gastrointestinal bleeding varies widely in the literature but nowadays seems low [75]. Pre-existing peptic ulcer disease and non-steroidal anti-inflammatory drugs are known risk factors while post-operative use of aspirin is not likely to be a strong risk factor.…”

Section: Gastrointestinal Complicationsmentioning

confidence: 99%

Post-operative Management

Pioli

Bendini

Pignedoli

2020

Practical Issues in Geriatrics

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The management of hip fracture in older people in the post-operative setting requires a multidisciplinary approach and geriatric competencies. The main goals of the post-operative stage are early mobilisation and prevention of complications. To achieve the goal of early mobilisation a stable surgical repair is essential, allowing the patient to bear weight as tolerated, as well as effective pain control and fluid management protocols, ensuring an adequate volume and avoiding orthostatic hypotension. Due to the age-related decline of the physiological reserve and function across multi-organ systems, patients with hip fracture are at risk of multiple complications. Almost every organ is vulnerable, although cognitive dysfunction, cardiac complications and infections are the most frequent and clinically significant. In most common conditions a systematic approach in the management of hip fracture, through a checklist for each professional and shared protocols, is an established method to improve the quality of the intervention and reduce post-operative complications. The vulnerability to complications of older patients with hip fractures may last for several days after surgical repair. However, this group of patients is at high risk of deconditioning in hospital and thus early discharge-planning based on discharge needs is a crucial component in the management of the acute episode.

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“… 5 The mortality rate in hip fractures in the elderly is approximately 10% over the first month and 33% within the first year. 1 , 4 , 6 , 7 Peri-operative complications including gastrointestinal bleeding are the main determinants of outcomes and the leading cause of morbidity and mortality in elderly patients with hip fractures. 3 , 6 – 8 …”

Section: Introductionmentioning

confidence: 99%

“… 1 , 4 , 6 , 7 Peri-operative complications including gastrointestinal bleeding are the main determinants of outcomes and the leading cause of morbidity and mortality in elderly patients with hip fractures. 3 , 6 – 8 …”

Section: Introductionmentioning

confidence: 99%

“… 2 The incidence of peri-operative acute UGIB ranges between 0.39% and 15% in patients with hip fractures. 6 , 7 However, the incidence of clinically important UGIB is between 1% and 4% with a mortality rate as high as 50%. 9 , 13 Acute upper gastrointestinal bleeding is often overlooked as a potential major cause of morbidity and mortality in the elderly with femoral neck fractures.…”

Section: Introductionmentioning

confidence: 99%

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Should we routinely prescribe proton pump inhibitors peri-operatively in elderly patients with hip fractures? A review of the literature

et al. 2021

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Elderly hip fracture patients are at risk of stress-related gastric mucosal damage, and upper gastrointestinal bleeding is one of the underrecognized but devastating complications. Proton pump inhibitors (PPIs) offer effective prophylaxis against stress-related gastric mucosal damage. Systematic analysis of the literature revealed numerous articles on PPIs and hip fractures, but only three articles dedicated to the analysis of prophylactic use of PPIs in patients with a hip fracture. There is significant reduction in upper gastrointestinal bleeding following PPI prophylaxis and reduced 90-day mortality in elderly hip fracture patients on prophylaxis. PPIs are generally safe, cost-effective and based on available evidence. Their prophylactic use is justifiable in elderly patients with hip fractures. We suggest that PPIs be prescribed routinely peri-operatively in elderly hip fracture patients. Further level-one studies on the subject will allow for firmer recommendations. Cite this article: EFORT Open Rev 2021;6:686-691. DOI: 10.1302/2058-5241.6.200053

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Upper gastrointestinal bleeding in neck of femur fracture patients: a single tertiary centre experience

Cited by 4 publications

References 20 publications

Adherence to medication, glycaemic control and hospital attendance in young adults with type 2 diabetes

Adherence to medication, glycaemic control and hospital attendance in young adults with type 2 diabetes

Post-operative Management

Should we routinely prescribe proton pump inhibitors peri-operatively in elderly patients with hip fractures? A review of the literature

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