Urinary retention as a postoperative complication associated with functional decline in elderly female patients with femoral neck and trochanteric fractures

Higashikawa, Toshihiro; Shigemoto, Kazuhiro; Goshima, Kenichi; Usuda, Daisuke; Okuro, Masashi; Moriyama, Manabu; Inujima, Hiromi; Hangyou, Masahiro; Usuda, Kimiko; Morimoto, Shigeto; Matsumoto, Tadami; Takashima, Shigeki; Kanda, Tsugiyasu; Sawaguchi, Takahiro

doi:10.1097/md.0000000000016023

Cited by 26 publications

(17 citation statements)

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“…It adversely affects the functional outcome of female patients but is not associated with increased mortality rates [10]. Our retrospective study has demonstrated that cognitive function as well as ADL were the important risk factors for urinary retention, suggesting that the postoperative management of urinary retention is important with taking account of neurofunctional assistance and nursing care in daily living, especially in elderly female patients receiving surgery of femoral neck and trochanteric fractures [11]. Complications after hip fracture surgery were common.…”

Section: Discussionmentioning

confidence: 87%

Mortality and the Risk Factors in Elderly Female Patients With Femoral Neck and Trochanteric Fractures

et al. 2020

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Background: The main purpose of this study is to exhaustively explore risk factors, including age, gender, and several clinical indices, for mortality in elderly patients with femoral neck fracture and to evaluate some of them using survival analyses. Methods: This was a retrospective study tracking 1 year for vital prognosis. Data were collected at post-operation from medical records of the cases. Survival analysis was conducted to investigate the risk factors for death, including albumin, urinary retention, activity of daily living (ADL), and cognitive disorder. Results: We recruited 318 patients with a history of hip surgery carried out at Toyama Municipal Hospital, in which 39 patients died for 1 year after discharge. The results showed a significant decrease in survival rate in low albumin, positive urinary retention, and low ADL (P < 0.01, by log-rank test). The hazard ratios (95% confidence interval) of albumin, urinary retention, ADL, and cognitive disorder were 0.36 (0.19-0.69), 0.4 (0.2-0.8), 0.29 (0.15-0.58) and 0.65 (0.32-1.29), respectively. Conclusions: This study demonstrated that albumin, urinary retention and ADL were the important risk factors for mortality, and suggested that the postoperative management of albumin, urinary retention and ADL is important, especially in elderly female patients receiving surgery of femoral neck and trochanteric fractures.

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Section: Discussionmentioning

confidence: 87%

Mortality and the Risk Factors in Elderly Female Patients With Femoral Neck and Trochanteric Fractures

et al. 2020

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“…In a 2019 retrospective cohort study in which 221 female patients (age 85.3 ± 7.0 years) with a history of hip surgery, urinary retention occurred in 34 out of the 221 cases (15.4%) and was significantly associated with cognitive impairment (OR 4.11, 95% CI 1.53-11.03, P = 0.005) and ADL (OR 2.61, 95% CI 1.11-6.18, P = 0 .029), under adjustment with age and body mass index (BMI). This study demonstrated that cognitive function and ADL were important risk factors for urinary retention, and suggested that the postoperative management of urinary retention is important when considering neurofunctional assistance and nursing care in daily living, especially in elderly female patients undergoing surgery after femoral neck and trochanteric fractures [171]. A 2014 clinical study of risk factors for urinary retention including 72 fe-male elderly patients undergoing hip surgery showed that the early removal of the urethral catheter (per 1-day indwelling period increase, OR 0.33, 95% CI 0.11-0.96, P = 0.04) and preoperative dementia and/or delirium (OR 10.4, 95% CI 1.21-89.2, P = 0.03) had significant correlations with postoperative urinary retention.…”

Section: Prevention Of Urinary Tract Infectionsmentioning

confidence: 80%

Anesthetic management of geriatric patients

Lim

2020

Korean J Anesthesiol

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The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.

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“…AUR causes multiple acute (pain, discomfort, decreased consciousness) and late (urinary tract infections, sepsis, urinary incontinence) complications [12,24]. Between the main risk factors we can nd the rst 24 postoperative hours and being male, due to the increase in the size of the prostate, but AUR may be also adversely affected by cognitive impairment, hypothyroidism, vascular insu ciency, the administration of drugs such as opioids and the rest in bed because of the hip fracture [25]. The prevalence of AUR described in the literature is very variable (5-70%) [12,24] being in our sample 11.3% in 2012 and 46.3% in 2017.…”

Section: Discussionmentioning

confidence: 99%

Influence of Orthogeriatrics on the Morbidity and Mortality of Patients with Hip Fracture.

Balvís-Balvís¹,

Domínguez-Prado²,

Ferradas-Garcia³

et al. 2020

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BACKGROUND: Osteoporotic hip fractures often occur in fragile, elderly patients and are associated with a significant morbidity and mortality. The objective of this study is to evaluate the morbidity and mortality together with the length of hospital stay in patients with hip fracture in two non-consecutive years and to compare their evolution with the involvement of a specialist in orthogeriatric care.MATERIAL AND METHODS: Retrospective study that reviewed a total of 633 patients with an average age of 85.5 years who suffered a hip fracture and were treated in the same service of Trauma and Orthopaedics in two different years (2012 and 2017). We have analysed mortality, morbidity during their hospital stay, the length of hospital stays and the cost-benefit after the implication of a specialist in orthogeriatric care in 2017.RESULTS: Mortality during their hospital stay decreased significantly from 10% in 2012 to 3.6% in 2017. We have also observed a decrease in mortality at 30 days (10.5% versus 7%) and after one year (28.9% versus 24.9%) between both groups, although these differences were not statistically significant. The length of hospital stays decreased significantly between both periods observed. The average stay decreased by 4.8 days, the surgical delay decreased by 1.1 days and the postoperative hospital stay decreased by 3.4 days. The total annual economic savings estimated due to the involvement of a geriatrician in the follow-up of patients with hip fracture was 1,017.084.94€.CONCLUSIONS: The multidisciplinary approach of patients with hip fracture results in a more effective and more efficient care model. The quality of care and the clinical care optimisation of patients in the perioperative period improve and both hospital stay and mortality during hospital stay decrease significantly. A significant economic saving is also obtained in the treatment of this pathology.

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Urinary retention as a postoperative complication associated with functional decline in elderly female patients with femoral neck and trochanteric fractures

Cited by 26 publications

References 20 publications

Mortality and the Risk Factors in Elderly Female Patients With Femoral Neck and Trochanteric Fractures

Mortality and the Risk Factors in Elderly Female Patients With Femoral Neck and Trochanteric Fractures

Anesthetic management of geriatric patients

Influence of Orthogeriatrics on the Morbidity and Mortality of Patients with Hip Fracture.

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