Atrial fibrillation as a preoperative risk factor predicts long-term mortality in elderly patients without heart failure and undergoing hip fracture surgery

Orhan, Ahmet Lütfüllah; Çınar, Tufan; Hayıroğlu, Mert İlker; Çiçek, Vedat; Selçuk, Murat; Doğan, Selami; Asal, Süha; Yavuz, Samet; Orhan, Serdar; Keser, Nurgül

doi:10.1590/1806-9282.20210686

Cited by 8 publications

(7 citation statements)

References 16 publications

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“… 7 AF is the risk factor for in-hospital mortality and long-term mortality in elderly patients undergoing hip fracture surgery. 41 , 42 In our study, although POAF did not show an influence on mortality, it was associated with perioperative myocardial infarction, acute kidney injury, and complications, such as infection, fistula, and bleeding. Patients with AF had prolonged mechanical ventilation time, ICU, and hospital length of stay.…”

Section: Discussioncontrasting

confidence: 51%

Association of Mitral Regurgitation with Postoperative Atrial Fibrillation in Critically Ill Noncardiac Surgery Patients: A Prospective Cohort Study

Zhang¹,

Wang²,

Jiang³

et al. 2023

IJGM

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Purpose Atrial fibrillation (AF) is common in critically ill patients and can have serious consequences. Postoperative AF (POAF) in critically ill patients following noncardiac surgery has been understudied, contrary to cardiac procedures. Mitral regurgitation (MR) is associated with left ventricular dysfunction, which might contribute to the occurrence of AF in postoperative critically ill patients. This study aimed to investigate the association between MR and POAF in critically ill noncardiac surgery patients and establish a new nomogram for the prediction of POAF in critically ill noncardiac surgery patients. Patients and Methods A prospective cohort of 2474 patients who underwent thoracic and general surgery was enrolled in this study. Data on preoperative transthoracic echocardiography (TTE), electrocardiogram (ECG), and several commonly utilized scoring systems (CHA2DS2‐VASc, HATCH, COM-AF, HART, and C2HEST) and baseline clinical data were collected. Independent predictors were selected by univariate and multivariable logistic regression analysis, and a nomogram was constructed for POAF within 7 days after postoperative intensive care unit (ICU) admission. The ability of the MR-nomogram and other scoring systems to predict POAF was compared by receiver operator characteristic (ROC) curve analysis and decision curve analysis (DCA). Additional contributions were evaluated by integrated discrimination improvement (IDI) and net reclassification improvement (NRI) analysis. Results A total of 213 (8.6%) patients developed POAF within 7 days after ICU admission. Compared to CHA2DS2‐VASc, HATCH, COM-AF, HART, and C2HEST scoring systems, MR-nomogram showed better predictive ability for POAF with an area under the ROC curve of 0.824 (95% confidence interval: 0.805–0.842, p < 0.001). The improvement of the MR-nomogram in predictive value was supported by NRI and IDI analysis. The net benefit of the MR nomogram was maximal in DCA. Conclusion MR is an independent risk factor of POAF in critically ill noncardiac surgery patients. The nomogram predicted POAF better than other scoring systems.

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Section: Discussioncontrasting

confidence: 51%

Association of Mitral Regurgitation with Postoperative Atrial Fibrillation in Critically Ill Noncardiac Surgery Patients: A Prospective Cohort Study

Zhang¹,

Wang²,

Jiang³

et al. 2023

IJGM

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“…43,44 Hip fractures are one of the most commonly occurring co-morbidities of chronic kidney diseases, 16,45,46 and are associated with poor prognostic outcomes in terms of short-, long-term morbidity and mortality, especially for patients undergoing hemodialysis. [47][48][49][50] Current studies suggest that this predisposition toward fractures is a result of increased parathyroid hormone levels and the disruption in calcium-phosphorus metabolism in chronic kidney disease patients. 51,52 Studies have also suggested a direct relationship between the incidences of fracture and the severity of chronic kidney disease.…”

Section: Discussionmentioning

confidence: 99%

RETRACTED: The impact of chronic kidney disease and dialysis therapy on outcomes of elderly patients with hip fractures: A systematic review and meta-analysis

Lan¹,

Zhang²,

Sheng³

et al. 2022

Scott Med J

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Background and aims Hip fractures are a commonly occurring comorbidity in patients with chronic kidney disease. To evaluate the comparative rates of post-operative complications, revision surgery, and mortality after hip fracture surgery in chronic kidney disease patients undergoing hemodialysis. Methods A systematic search of the academic literature was performed according to the PRISMA guidelines across five databases: Web of Science, EMBASE, CENTRAL, Scopus, and MEDLINE. A random-effect meta-analysis was conducted to evaluate the overall comparative risks of post-operative complications in chronic kidney disease patients. Results Out of 993 studies, 11 eligible studies were included in the review, with a total of 72618 chronic kidney disease patients (mean age: 75.3 ± 3.0 years), and 50566 healthy controls (75.3 ± 2.6 years). Meta-analysis revealed a higher risk of post-operative complications (Odd's ratio: 1.76), revision surgeries (1.69), and mortality-related outcomes (2.47) after hip fracture surgery in chronic kidney disease patients undergoing hemodialysis as compared to chronic kidney disease patients not undergoing hemodialysis. Conclusion We report higher risks of post-operative complications, revision surgery, and mortality in chronic kidney disease patients undergoing hemodialysis as compared to chronic kidney disease patients not undergoing hemodialysis.

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“…Elderly patients with decreased physiological reserve and poor tolerance to fracture‐caused traumatic stress and who have undergone surgery might have higher perioperative risk. Old age has also been reported as an independent predictive factor for death in elderly patients with hip fractures 28 . Age is the main risk factor for death in elderly patients with femoral neck fractures at 30 days 29 and 1 year 30,31 after surgery.…”

Section: Discussionmentioning

confidence: 97%

“…Old age has also been reported as an independent predictive factor for death in elderly patients with hip fractures. 28 Age is the main risk factor for death in elderly patients with femoral neck fractures at 30 days 29 and 1 year 30,31 after surgery.…”

Section: Risk Factors Of Mortality After Artificial Hip Arthroplastymentioning

confidence: 99%

The Nomogram Model and Factors for the Postoperative Mortality of Elderly Patients with Femoral Neck Fracture Undergoing Artificial Hip Arthroplasty: A Single‐Institution 6‐Year Experience

Wang,

Zhang,

Zeng

et al. 2023

Orthopaedic Surgery

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ObjectiveArtificial hip arthroplasty (AHA) is widely accepted in elderly patients with femoral neck fractures, but it is associated with high risk of death and various postoperative complications due to old age and accompanying chronic diseases. Therefore, this study aimed to explore the risk factors for death in elderly patients with femoral neck fractures after AHA and to establish a nomogram risk prediction model, which is expected to reveal high‐risk patients and improve the postoperative quality of life and survival rate of patients.MethodsElderly patients who underwent AHA for femoral neck fractures in our hospital from September 2014 to May 2021were retrospectively analyzed. These patients were divided into a survival group and a death group according to their clinical outcomes. The following clinical data were recorded for the patients in the two groups: sex, age, underlying diseases, smoking and drinking history, preoperative nutritional risk score (NRS) and American Society of Anesthesiologists (ASA) score, as well as relevant indicators about the operation. These data were subject to univariate analysis and then logistic analysis to determine the risk factors of death. Subsequently, a nomogram risk prediction model was established and further validated with the receiver operating characteristic curve (ROC) and the Hosmer–Lemeshow test. Finally, the effects of predictive risk factors were analyzed using the Kaplan–Meier survival curve.ResultsFollow‐up was completed by 260 patients, including 206 patients in the survival group and 54 patients in the death group; the overall death rate was 20.77%, and the follow‐up time, age, postoperative 1, 3 and 5‐year death rates were 3.47 ± 1.93 years, 75.32 ± 9.12 years, 5.77%, 12.51%, and 25.61%, respectively. The top three causes of death in 54 patients were respiratory disease, cerebrocardiovascular disease, and digestive disease, respectively. The logistic analysis indicated that elderly patients with femoral neck fractures, the risk factors for death after AHA were age ≥ 80 years, preoperative NRS ≥ 4, HB ≤ 90 g/L, CR ≥ 110 umol/L, and ASA score ≥ 3, as well as postoperative albumin ≤ 35 g/L, the nomogram was established, and then its predictive performance was successfully validated using the ROC curve (AUC = 0.814, 95% confidence interval = 0.749–0.879) and the Hosmer–Lemeshow test (p = 0.840). Furthermore, Kaplan–Meier survival curve analysis revealed that the abovementioned six indicators were correlated with the post‐AHA survival time of elderly patients with femoral neck fractures (pLog Rank < 0.05).ConclusionOld age, preoperatively high NRS and ASA score, anemia, poor renal function, and postoperative hypoproteinemia are the major risk factors for death in elderly patients with femoral neck fractures after AHA; they are also associated with postoperative survival. Early identification and effective interventions for optimization of modifiable risk factors are recommended to improve the postoperative quality of life and survival rates.

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Atrial fibrillation as a preoperative risk factor predicts long-term mortality in elderly patients without heart failure and undergoing hip fracture surgery

Cited by 8 publications

References 16 publications

Association of Mitral Regurgitation with Postoperative Atrial Fibrillation in Critically Ill Noncardiac Surgery Patients: A Prospective Cohort Study

Association of Mitral Regurgitation with Postoperative Atrial Fibrillation in Critically Ill Noncardiac Surgery Patients: A Prospective Cohort Study

RETRACTED: The impact of chronic kidney disease and dialysis therapy on outcomes of elderly patients with hip fractures: A systematic review and meta-analysis

The Nomogram Model and Factors for the Postoperative Mortality of Elderly Patients with Femoral Neck Fracture Undergoing Artificial Hip Arthroplasty: A Single‐Institution 6‐Year Experience

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