To examine prognostic factors that influence complications after hip fracture surgery. To summarise proposed underlying mechanisms for their influence.
MethodsWe reported according to Preferred Reporting Items for Systematic Review and Meta-Analysis Scoping Review extension. We searched MEDLINE, Embase, CINAHL, AgeLine, Cochrane Library, and reference lists of retrieved studies for studies of prognostic factor/s of postoperative in-hospital medical complication/s among patients 50 years and older treated surgically for non-pathological closed hip fracture, published in English January 2008 -January 2018. We excluded studies of surgery type or in-hospital medications. Screening was duplicated by two independent reviewers. One reviewer completed extraction with accuracy checks by a second. We summarised extent, nature, and proposed underlying mechanisms for prognostic factors of complications narratively and in a dependency graph.
ResultsWe identified 44 prognostic factors of in-hospital complications after hip fracture surgery from 56 studies. Of these, we identified 7 patient factors-dehydration, anaemia, hypotension, heart rate variability, pressure risk, nutrition, indwelling catheter use; and 7 process factors-time to surgery, anaesthetic type, transfusion strategy, orthopaedic versus geriatric/comanaged care, and multidisciplinary care pathway, potentially modifiable during index hospitalisation. We identified underlying mechanisms for 15 of 44 factors. The reported association between 12 prognostic factors and complications was inconsistent across studies.
ConclusionsMost factors were reported by one study with no proposed underlying mechanism for their influence. Where reported by more than one study, there was inconsistency in reported associations and the conceptualisation of complications differed, limiting comparison across studies. It is therefore not possible to be certain whether intervening on these factors would reduce the rate of complications after hip fracture surgery.
Discussions surrounding the future of artificial intelligenc (AI) in healthcare often cause consternation among healthcare professionals. These feelings may stem from a lack of formal education on AI and how to be a leader of AI implementation in medical systems. To address this, our academic medical center hosted an educational summit exploring how to become a leader of AI in healthcare. This article presents three lessons learned from hosting this summit, thus providing guidance for developing medical curriculum on the topic of AI in healthcare.
Background: Radiocarpal dislocations are rare injuries that result from high-energy forces across the wrist with the hallmark finding of radiocarpal ligament disruption. Published treatment methods are comprehensive with moderate-to-good outcomes. The purpose of this study was to review the treatment of radiocarpal dislocations with a dorsal wrist spanning plate. Methods: A retrospective review was conducted analyzing the radiographic and clinical outcomes of patients treated for a radiocarpal dislocation using a dorsal wrist spanning plate over a 10-year period. Outcomes assessed included radiographic joint incongruity and arthrosis, wrist range of motion, grip strength, Visual Analogue Scale (VAS) score, surgical complications, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results: Thirteen patients were treated with a dorsal wrist spanning plate for radiocarpal dislocation with a mean follow-up of 615 days from the time of initial surgery. Six patients (46%) had associated distal radioulnar joint instability. The mean wrist range of motion at the final follow-up was: flexion 39°, extension 44°, pronation 79°, and supination 84°. One patient (8%) developed ulnar translation of the carpus, and 11 patients (85%) developed radiographic posttraumatic wrist arthrosis. Mean VAS and DASH scores were 4 and 18, respectively. Conclusions: Acute treatment with a dorsal wrist spanning plate in this series resulted in comparable outcomes to what have been previously reported in the literature. The dorsal wrist spanning plate offers the surgeon a reliable method of stabilization, with minimal additional surgical trauma to the wrist, while avoiding the potential for infections that develop with other treatment methods.
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