Comorbidity as a predictor of mortality and mobility after hip fracture

González-Zabaleta, Jorge; Pita-Fernández, Salvador; Seoane-Pillado, Teresa; López‐Calviño, Beatriz

doi:10.1111/ggi.12510

Cited by 63 publications

(38 citation statements)

References 29 publications

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“…This indicates a floor effect in terms of return to function with poorer pre-fracture ambulation status and is consistent with previous reports documenting decreased odds of change in ambulatory status as pre-fracture ambulatory function decreases. 4,30 Other studies have reported an association between poor recovery of ambulation after hip fracture repair and CCI 24,31 and delirium episodes, 4 similar to the STRIDE results.…”

Section: Discussionsupporting

confidence: 63%

Depth of sedation as an interventional target to reduce postoperative delirium: mortality and functional outcomes of the Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients randomised clinical trial

Sieber

Neufeld

Gottschalk

et al. 2019

British Journal of Anaesthesia

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Background: The Strategy to Reduce the Incidence of Postoperative Delirium in the Elderly trial tested the hypothesis that limiting sedation during spinal anaesthesia decreases in-hospital postoperative delirium after hip fracture repair. This manuscript reports the secondary outcomes of this trial, including mortality and function.Methods: Two hundred patients (!65 yr) undergoing hip fracture repair with spinal anaesthesia were randomised to heavier [modified Observer's Assessment of Alertness/Sedation score (OAA/S) 0e2] or lighter (OAA/S 3e5) sedation, and were assessed for postoperative delirium. Secondary outcomes included mortality and return to pre-fracture ambulation level at 1 yr. KaplaneMeier analysis, multivariable Cox proportional hazard model, and logistic regression were used to evaluate intervention effects on mortality and odds of ambulation return. Results: One-year mortality was 14% in both groups (log rank P¼0.96). Independent risk factors for 1-yr mortality included: Charlson comorbidity index [hazard ratio (HR)¼1.23, 95% confidence interval (CI), 1.02e1.49; P¼0.03], instrumental activities of daily living [HR¼0.74, 95% CI, 0.60e0.91; P¼0.005], BMI [HR¼0.91, 95% CI 0.84e0.998; P¼0.04], and delirium severity [HR¼1.20, 95% CI, 1.03e1.41; P¼0.02]. Ambulation returned to pre-fracture levels, worsened, or was not obtained in 64%, 30%, and 6% of 1 yr survivors, respectively. Lighter sedation did not improve odds of ambulation return at 1 yr [odds ratio (OR)¼0.76, 95% CI, 0.24e2.4; P¼0.63]. Independent risk factors for ambulation return included Charlson comorbidity index [OR¼0.71, 95% CI, 0.53e0.97; P¼0.03] and delirium [OR¼0.32, 95% CI, 0.10e0.97; P¼0.04].Conclusions: This study found that in elderly patients having hip fracture surgery with spinal anaesthesia supplemented with propofol sedation, heavier intraoperative sedation was not associated with significant differences in mortality or return to pre-fracture ambulation up to 1 yr after surgery. Clinical trial registration: ClinicalTrials.gov NCT00590707.

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Section: Discussionsupporting

confidence: 63%

Depth of sedation as an interventional target to reduce postoperative delirium: mortality and functional outcomes of the Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients randomised clinical trial

Sieber

Neufeld

Gottschalk

et al. 2019

British Journal of Anaesthesia

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“…The main reason for these fractures in this age group is a simple fall in combination with an osteoporotic bone. Multiple comorbidities are complicating the perioperative procedure in these patients [2]. The functional outcome in this age group about activities of daily living and selfcapability is mainly determined by the patients' previous health status and the treatment in the acute hospital [3,4].…”

Section: Introductionmentioning

confidence: 99%

Cement augmentation of the Proximal Femoral Nail Antirotation (PFNA) – A multicentre randomized controlled trial

Kammerlander

Hem

Klopfer

et al. 2018

Injury

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“…Elderly patients with cardiovascular and respiratory comorbid diseases experience increased complications and mortality rates (3)(4)(5)(6). Previous national and international studies have investigated risk factors that affect morbidity and mortality in these patients, including age, sex, ASA score, present comorbid diseases, drug usage, type of fracture, surgical interventions, method of anesthesia, duration of surgery, patients' referral time to the emergency ward (IWH, in working hours; OWH, out of working hours), time before surgery, and intensive care unit (ICU) and hospital stay durations.…”

Section: Introductionmentioning

confidence: 99%

One-Year Retrospective Evaluation of Hip Fracture Patients Aged More than 80 Years and Postoperatively Monitored in the Intensive Care Unit

Daşar¹

2018

tjgeri

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Introduction:As in all the world, expected life time has extended in our country as well which increases yearly operated elderly patient rate. Surgical intervention for hip fracture is one of the most common operations among them Materials and Method: This study was done between 2014 and 2015 at Karabük Education and Research Hospital ICU. Who were older than age of 80, operated for hip surgery and monitorized at ICU postoperatively included to study.Results: The mean age of our patients was 84.65±3.36 years, and 50 of them were female (69.44%). 40 patients showed trochanteric femur fracture and 32 showed femoral neck fracture. Proximal femoral nail was implanted in 38 patients and partial hip prosthesis in 34. Regional anesthesia was administered to 57 patients and general anesthesia to 15. The hospital mortality rate was 16.6%.When we grouped the patients as surviving (60) or died (12), we found that the time before surgery was significantly longer for the died patients than for the surviving ones. The need for MV, duration of MV, and the need for inotropic agents were higher in died patients. The duration of ICU follow-up and hospital stay were longer for died patients. Other parameters showed no significant differences.Conclusion: In our study, mental status of our patients and post-discharge conditions could not be evaluated. Not describing the cause of delay to the surgery and not recording patient satisfaction was other limitations. Therefore, we have decided to form a new research protocol for evaluating patient satisfaction and causes of delay to the surgery.

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Comorbidity as a predictor of mortality and mobility after hip fracture

Abstract: Comorbidity is the best predictor of mortality and mobility after hip fracture. Geriatr Gerontol Int 2016; 16: 561-569.

Cited by 63 publications

References 29 publications

Depth of sedation as an interventional target to reduce postoperative delirium: mortality and functional outcomes of the Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients randomised clinical trial

Depth of sedation as an interventional target to reduce postoperative delirium: mortality and functional outcomes of the Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients randomised clinical trial

Cement augmentation of the Proximal Femoral Nail Antirotation (PFNA) – A multicentre randomized controlled trial

One-Year Retrospective Evaluation of Hip Fracture Patients Aged More than 80 Years and Postoperatively Monitored in the Intensive Care Unit

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