Surgery for hip fractures is associated with high mortality and morbidity. The causes of poor outcome are not fully understood and may be related to other factors than the surgery itself. The relative contributions of patient, surgical, anaesthetic and structural factors have seldom been studied together. This study, a retrospective registry-based cohort study of 14 932 patients undergoing hip fracture surgery in Sweden from 1st of January 2014 to 31st of December 2016, aimed to identify important predictors of mortality post-surgery. The independent predictive power of our included variables was examined using Cox proportional hazards modeling with all-cause mortality at longest follow-up as the outcome. Twelve independent variables were considered as interrelated ‘exposures’ and their individual adjusted effect within a single model were evaluated. Kaplan-Meier curves were also generated. Crude mortality rates were 8.2% at 30 days (95% CI 7.7–8.6%) and 23.6% at 365 days (95% CI 22.9–24.2%). Of the 12 factors entered into the Cox regression analysis, age (aHR1.06, p < 0.001), male gender (aHR 1.45, p < 0.001), ASA-PS-class (ASA 1&2 reference; ASA 3 aHR 2.12; ASA 4 aHR 4.79; ASA 5 aHR 12.57 respectively, p < 0.001) and PACU-LOS (aHR 1.01, p < 0.001) were significantly associated with mortality at longest follow-up (up to 3 years). University hospital status was protective (aHR 0.83, p < 0.001) in the same model. Age, gender and ASA-PS-class were strong predictors of mortality after surgery for hip fractures in Sweden. University hospital status and length of stay in the postoperative care unit were also identified as modifiable risk factors after multivariable adjustment and require confirmation in future studies.

BACKGROUND Mortality among patients admitted to intensive care units (ICUs) with COVID-19 is unclear due to variable follow-up periods. Few nationwide data are available to compare risk factors, treatment and outcomes of COVID-19 patients after ICU admission. OBJECTIVE To evaluate baseline characteristics, treatments and 30-day outcomes of patients admitted to Swedish ICUs with COVID-19. DESIGN Registry-based cohort study with prospective data collection. SETTING Admissions to Swedish ICUs from 6 March to 6 May 2020 with laboratory confirmed COVID-19 disease. PARTICIPANTS Adult patients admitted to Swedish ICUs. EXPOSURES Baseline characteristics, intensive care treatments and organ failures. MAIN OUTCOMES AND MEASURES The primary outcome was 30-day all-cause mortality. A multivariable model was used to determine the independent association between potential predictor variables and death. RESULTS We identified 1563 patients with complete 30-day follow-up. The 30-day all-cause mortality was 26.7%. Median age was 61 [52 to 69], Simplified Acute Physiology Score III (SAPS III) was 53 [46 to 59] and 62.5% had at least one comorbidity. Median PaO2/FiO2 on admission was 97.5 [75.0 to 140.6] mmHg, 74.7% suffered from moderate-to-severe acute respiratory failure. Age, male sex [adjusted odds ratio (aOR) 1.5 (1.1 to 2.2)], SAPS III score [aOR 1.3 (1.2 to 1.4)], severe respiratory failure [aOR 3.0 (2.0 to 4.7)], specific COVID-19 pharmacotherapy [aOR 1.4 (1.0 to 1.9)] and continuous renal replacement therapy [aOR 2.1 (1.5 to 3.0)] were associated with increased mortality. Except for chronic lung disease, the presence of comorbidities was not independently associated with mortality. CONCLUSIONS Thirty-day mortality rate in COVID-19 patients admitted to Swedish ICUs is generally lower than previously reported despite a severe degree of hypoxaemia on admission. Mortality was driven by age, baseline disease severity, the presence and degree of organ failure, rather than pre-existing comorbidities. TRIAL REGISTRATION NO NCT04462393

Background The mortality of patients admitted to the intensive care unit (ICU) with COVID-19 is unclear due to variable censoring and substantial proportions of undischarged patients at follow-up. Nationwide data have not been previously reported. We studied the outcomes of Swedish patients at 30 days after ICU admission. Methods We conducted a registry-based cohort study of all adult patients admitted to Swedish ICUs from 6 March-6 May, 2020 with laboratory confirmed COVID-19 disease and complete 30-day follow-up. Data including baseline characteristics, comorbidities, intensive care treatments, organ failures and outcomes were collected. The primary outcome was 30-day all-cause mortality. A multivariable model was used to determine the independent association between potential predictor variables and the primary outcome. Results A total of 1563 patients were identified. Median ICU length of stay was 12 (5-21) days, and fifteen patients remained in ICU at the time of follow-up. Median age was 61 (52-69), median Simplified Acute Physiology Score III (SAPS III) was 53 (46-59), and 66.8% had at least one comorbidity. Median PaO2/FiO2 on admission was 97.5 (75.0-140.6) mmHg, 74.7% suffered from moderate to severe acute respiratory distress syndrome (ARDS). The 30-day all-cause mortality was 26.7%. The majority of deaths occurred during ICU admission. Age, male sex (adjusted odds ratio [aOR] 1.5 [1.1-2.1]), SAPS III score (aOR 1.3 [1.2-1.4]), severe ARDS (aOR 3.1 [2.0-4.8], specific COVID-19 pharmacotherapy (aOR 1.4 [1.0-1.9]), and CRRT (aOR 2.2 [1.6-3.0]), were associated with increased mortality. With the exception of chronic lung disease, the presence of comorbidities was not independently associated with mortality. Conclusions Thirty-day mortality rate in COVID-19 patients admitted to Swedish intensive care units is generally lower than previously reported. Mortality appears to be driven by age, baseline disease severity, the degree of organ failure and ICU treatment, rather than preexisting comorbidities.

Background Left ventricular longitudinal strain (LVLS) may be a sensitive indicator of left ventricular (LV) systolic function in patients with sepsis, but is dependent on high image quality and analysis software. Mitral annular plane systolic excursion (MAPSE) and the novel left ventricular longitudinal wall fractional shortening (LV-LWFS) are bedside echocardiographic indicators of LV systolic function that are less dependent on image quality. Both are sparsely investigated in the critically ill population, and may potentially be used as surrogates for LVLS. We assessed if LVLS may be predicted by LV-LWFS and MAPSE in patients with septic shock. We also assessed the repeatability and inter-rater agreement of LVLS, LV-LWFS and MAPSE measurements. Results 122 TTE studies from 3 echocardiographic data repositories of patients admitted to ICU with septic shock were retrospectively assessed, of which 73 were suitable for LVLS analysis using speckle tracking. The correlations between LVLS vs. LV-LWFS and LVLS vs. MAPSE were 0.89 (p < 0.001) and 0.81 (p < 0.001) with mean squared errors of 5.8% and 9.1%, respectively. Using the generated regression equation, LV-LWFS predicted LVLS with a high degree of accuracy and precision, with bias and limits of agreement of -0.044 ± 4.7% and mean squared prediction error of 5.8%. Interobserver repeatability was good, with high intraclass correlation coefficients (0.96–0.97), small bias and tight limits of agreement (≤ 4.1% for all analyses) between observers for all measurements. Conclusions LV-LWFS may be used to estimate LVLS in patients with septic shock. MAPSE also performed well, but was slightly inferior compared to LV-LWFS in estimating LVLS. Feasibility of MAPSE and LV-LWFS was excellent, as was interobserver repeatability.

Background and goal of study: Hip fractures are the most common osteoporotic fractures in Sweden and are associated with high mortality and morbidity. The poor outcome is not fully understood and may be related to other factors than the surgery itself. After-hours surgery is a much-debated subject and is often considered a risk factor. However, literature regarding the impact of after-hours surgery is equivocal. The primary aim of this study is to investigate the effect of afterhours surgery on short-and mid-term mortalities (30 and 365 days) in Östergötland County Council. Secondary aims of the study are to analyze the impact of logistical changes at