Preoperative status and risk of complications in patients with hip fracture

Abstract

In this study of older adults undergoing urgent surgery, potentially reversible abnormalities in laboratory and physical examination occurred frequently and significantly increased the risk of postoperative complications. Major clinical abnormalities should be corrected prior to surgery, but patients with minor abnormalities may proceed to surgery with attention to these medical problems perioperatively.

Time to death in a prospective cohort of 252 patients treated for fracture of the proximal femur in a major hospital in Portugal

“…Although the optimal time for surgery after PFF in the elderly is not clear, most authors report that early surgical intervention (< 24, < 48, or < 72 hours) is associated with better prognosis and improved health status 15,31,32 . Delay to surgery prolongs hospital stay and increases the risk of pulmonary embolism, deep venous thrombosis, heart failure, urinary infection, and pressure sores 33,34,35 , thus delaying rehabilitation and increasing the risk of death. Table 2 Age-adjusted hazard ratios (HR) for one-year mortality after proximal femur fracture.…”

Effect of Inpatient Quality of Care on Functional Outcomes in Patients With Hip Fracture

“…In previous studies, we found that 13% of the patients experienced major hospital complications 18 and a third of the patients were readmitted to the hospital within 6 months. Many were readmitted more than once.…”

“…Our findings suggest that the benefits of better process are not sustained if complications and hospital readmission occur. However, the opportunity to fully realize the benefits in functional outcome may exist given that modifiable risk factors have been described for hip fracture complications 18 and interventions have been developed to reduce readmissions in elderly patients. 44 In addition, our findings have important implications for research on and applications of quality measures in healthcare.…”

“…The FIM includes 3 subscales of physical functioning: (1) locomotion (a 2-item subscale [range, [2][3][4][5][6][7][8][9][10][11][12][13][14] focusing on walking and climbing stairs), (2) self care (a 6-item scale [range, of self-care activities, including bathing and dressing), and (3) transferring (a 3-item scale [range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] focusing on transfers from the bed, toilet, and tub). Each item was scored between 1 (for complete dependence) and 7 (for complete independence) using specific criteria.…”

“…16 We additionally included information from recently completed studies from our group. 8,10,[17][18][19] We found that extensive randomized trial evidence was available for only 3 issues at best-antibiotic prophylaxis, [20][21][22] prevention of thromboembolism,23 -26 and nutritional support.27 -30 For several issues (urinary tract care and collaborative rehabilitation), the randomized trials were fewer and smaller. 31 Similarly, there were few randomized trials available for a number of important clinical topics including timing of surgery, early mobilization, and intensity of physical therapy, although some well-conducted observational studies were available.…”