Patient and Perioperative Factors Influencing the Functional Outcomes and Mortality in Elderly Hip Fractures

Meng, Defei; Bai, Xin; Wu, Haotian; Yao, Shuangquan; Ren, Pengcheng; Bai, Xiaodong; Lu, Chongyao; Song, Zhaohui

doi:10.1080/08941939.2019.1625985

Cited by 21 publications

(20 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…But due to the limited cases (17 cases), this association was not definitive and its mechanism requires to be further investigated. The role of preoperative stay in risk of SSI in elective foot and ankle surgery should be rationally treated because the causes might be multifactorial, such as more time needed for optimization of comorbidities, unavailability of operation resources, weekends, or holidays [30,31]. About 5% of patients in this study had an increased neutrophil count (> 6.3 × 10 9 /L), in whom the incidence rate of SSI was 7.8%, significantly higher than those with normal range of neutrophil count.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for surgical site infection following elective foot and ankle surgery: a retrospective study

Meng

Zhu

et al. 2020

J Orthop Surg Res

View full text Add to dashboard Cite

Background This study aimed to investigate the incidence of surgical site infection (SSI) in elective foot and ankle surgeries and identify the associated risk factors. Methods This was designed as a retrospective study, including patients who underwent elective surgery of foot and ankle between July 2015 and June 2018. Data on demographics, comorbidities, and perioperative parameters were collected from the medical records, the laboratory report, the operation report, and the outpatient follow-up registration database. SSI was defined in accordance with the Center for Disease Control criteria. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for SSI. Results A total of 1201 patients undergoing 1259 elective foot/ankle surgeries were included, of whom 26 (2.1%) had an SSI, representing an incidence rate of 1.3% for superficial SSI and 0.8% for deep SSI, respectively. The results for organism culture showed Pseudomonas aeruginosa in 7 cases, methicillin-resistant Staphylococcus aureus (MRSA) in 6, methicillin-susceptible Staphylococcus aureus (MSSA) in 5, methicillin-resistant coagulase-negative Staphylococci (MRCNS) in 2, Escherichia coli in 2, and Proteus mirabilis in 1 case. Five factors were identified to be independently associated with SSI, including prolonged preoperative stay (OR, 1.21; 95% CI, 1.09 to 1.30), allograft or bone substitute (OR, 3.76; 95% CI, 1.51 to 5.30), elevated FBG level (OR, 1.17; 95% CI, 1.04 to 1.26), lower ALB level (OR, 2.33; 95% CI, 1.19 to 3.05), and abnormal NEUT count (OR, 1.72; 95% CI, 1.27 to 2.12). Conclusions SSI following elective foot and ankle surgeries is low, but relatively high in forefoot surgeries, requiring particular attention in clinical practice. Although most not modifiable, these identified factors aid in risk assessment of SSI and accordingly stratifying patients and therefore should be kept in mind.

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for surgical site infection following elective foot and ankle surgery: a retrospective study

Meng

Zhu

et al. 2020

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…In numerous studies, potential factors have been searched for that contribute to the risk of mortality or other complications following HF surgery. A recent retrospective study found that the WBC count, PLT count, and Hb level were independent factors influencing mortality in HF patients [ 16 ]. Therefore, the frequencies of Treg and Th17 cells and the ratio of Treg/Th17 cells were evaluated for correlations with the clinical parameters in HF patients using Spearman’s rank correlation coefficient to compare the frequencies of these cell subsets and clinical parameters, including the WBC count and, ALB and Hb levels, in our cohort within 24 h after injury.…”

Section: Resultsmentioning

confidence: 99%

Blood transfusion practices affect CD4+ CD25+ FOXP3+ regulatory T cells/T helper-17 cells and the clinical outcome of geriatric patients with hip fracture

Chen

Kang²,

Zhang

et al. 2021

Aging

View full text Add to dashboard Cite

Hip fracture (HF) is common among older individuals and associated with high mortality, poor vitality and functional impairment. HF patients suffer whole body immunological changes and that lead to severe consequences, including immobilization, physical impairment and a high risk of complications. The objective of this study was to decipher the pattern of dynamic immunological changes, especially in two major T cell subsets, CD4 + CD25 + FOXP3 + regulatory T (Treg) cells and T helper-17 (Th17) cells, and their balance, during the hospital stay and to observe whether blood transfusion could influence these cells and clinical patietns’ prognosis. In this study, ninety-eight consecutive HF patients were initially enrolled, and finally fifty-one patients qualified for the study, and correlation analysis of their clinical parameters was carried out to predict the meaning of their distribution in clinical practice. Our results showed that the frequency of Tregs gradually decreased, while the frequency of Th17 cells slowly increased in HF patients who received blood transfusion. The Treg frequency was inversely correlated with the level of hemoglobin (Hb), and Th17 cell frequency was positively related to fluctuations in Hb levels in HF patients after trauma. HF patients with a better prognosis and survival time showed decreased a Treg frequency and a decreased Treg/Th17 ratio. Transfusion helped reverse the imbalance in the frequencies of Tregs and Th17 cells and the Treg/Th17 ratio and especially contributed to a better outcome in HF patients with moderate-to-severe anemia. In conclusion, a higher frequency of peripheral blood Tregs and a higher Treg/Th17 ratio may be associated with unfavorable outcomes in HF patients, and blood transfusion may benefit moderate-to-severe HF patients rebalance their immune response.

show abstract

“…BMI closest to date of surgery, within 1 year, was used for analysis. Diabetes mellitus was selected as an explanatory variable because of known associations with mortality in the setting of hip fractures (Chang et al, 2018; Meng et al, 2019) and altered analgesic requirements (Weiner et al, 2019). Smoking status was selected as an explanatory variable cause of known associations with complications in the setting of hip fractures (Ray, Aitken, McQueen, Court‐Brown, & Ralston, 2015) and altered analgesic requirements (Flanagan, Wysong, Ramey, & Vallier, 2018; Kuwabara et al, 2014; Walters, Cleck, Kuo, & Blendy, 2005).…”

Section: Methodsmentioning

confidence: 99%

Factors associated with discharge opioid prescription after hip fracture fixation

Fandino

Bhashyam

Harris

et al. 2020

Musculoskeletal Care

View full text Add to dashboard Cite

Objective Opioid prescribing after hip fracture fixation is variable, but the factors that drive this prescribing variation are not well‐described. The purpose of this study was to determine independent factors associated with increased opioid prescription upon discharge after hip fracture fixation. Methods A retrospective cohort study of 296 adult patients who underwent hip fracture fixation between January 2016 and December 2017 at two Level I trauma centers were included in our study. The primary outcome measurement was opioid prescription at discharge in morphine milligram equivalents (MME). Bivariate analysis was used to screen for factors, and multivariable regression analysis was used to identify independent factors associated with opioid prescription upon discharge from the hospital. Results Discharge opioid prescription amounts were available for 280 out of 296 patients (95%). The mean (±standard deviation) discharge opioid prescription was 212 (±319) MME. Multivariable regression analysis showed that younger age (p = 0.004), diabetes mellitus (p = 0.02), smoking (p < 0.001), treatment at hospital #2 (p < 0.001), and weekend discharge (p = 0.03) were associated with increased opioid prescription at discharge. Conclusions Increased opioid prescribing after hip fracture fixation is associated with patient‐ and system‐related factors. Prescriber education programs, prescription guidelines, and safe handoff practices that focus on these factors may help to decrease prescription variability and opioid overprescription across institutions.

show abstract

Patient and Perioperative Factors Influencing the Functional Outcomes and Mortality in Elderly Hip Fractures

Cited by 21 publications

References 36 publications

Incidence and risk factors for surgical site infection following elective foot and ankle surgery: a retrospective study

Incidence and risk factors for surgical site infection following elective foot and ankle surgery: a retrospective study

Blood transfusion practices affect CD4+ CD25+ FOXP3+ regulatory T cells/T helper-17 cells and the clinical outcome of geriatric patients with hip fracture

Factors associated with discharge opioid prescription after hip fracture fixation

Contact Info

Product

Resources

About