Relationship between comorbidities and treatment decision-making in elderly hip fracture patients

Wei, Jinxin; Zeng, Li; Li, Shitong; Luo, Fang; Xiang, Zhou; Ding, Qianming

doi:10.1007/s40520-019-01134-5

Cited by 48 publications

(33 citation statements)

References 33 publications

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“…The most common comorbidity in older patients is hypertension, which affects 45-50% of patients over 70 years of age, followed by coronary artery disease (CAD) (35%); other common comorbidities include diabetes (12-15%) and chronic obstructive pulmonary disease (COPD) (9%) [34]. Comorbidities are strongly associated with increased surgical and postoperative risks, and increased health care costs [35]. Age-related changes in the cardiovascular and autonomic nervous systems reduce cardiac responsiveness to stress [36].…”

Section: Strength Of Recommendationmentioning

confidence: 99%

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

et al. 2020

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Background Surgical outcomes in geriatric patients may be complicated by factors such as multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment. An integrated multidisciplinary approach to management is, therefore, essential in this population, but at present, the use of such an approach is uncommon. The Perioperative Management of Elderly patients (PriME) project has been established to address this issue. Aims To develop evidence-based recommendations for the integrated care of geriatric surgical patients. Methods A 14-member Expert Task Force of surgeons, anesthetists, and geriatricians was established to develop evidence-based recommendations for the pre-, intra-, and postoperative care of hospitalized older patients (≥ 65 years) undergoing elective surgery. A modified Delphi approach was used to achieve consensus, and the strength of recommendations and quality of evidence was rated using the U.S. Preventative Services Task Force criteria. Results A total of 81 recommendations were proposed, covering preoperative evaluation and care (30 items), intraoperative management (19 items), and postoperative care and discharge (32 items). Conclusions These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of the surgeon, the anesthetist, the geriatrician, and other specialists and health care professionals (where available) as needed. These roles may vary according to the phase and setting of care and the patient’s conditions.

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Section: Strength Of Recommendationmentioning

confidence: 99%

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

et al. 2020

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“… 4–6 With regard to this, common risk factors of hip fractures in the elderly have also been reported in previous literature, which mainly includes advanced age, gender, smoking, drinking alcohol, hypertension, diabetes, and osteoporosis, and so on. 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

Prevalence, Characteristics, and Associated Risk Factors of the Elderly with Hip Fractures: A Cross-Sectional Analysis of NHANES 2005–2010

Zhang¹,

Lu²,

et al. 2021

CIA

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Objective This cross-sectional study was aimed to update the assessment of prevalence, characteristics, and risk factors of the elderly with hip fractures in a non-institutionalized American population. Methods This current study included a total of 31,034 participants from the existing National Health and Nutritional Examination Survey (NHANES) database from 2005 to 2010, and 4,265 participants aged 65 years and older were ultimately identified. Their condition of hip fractures was determined by method of questionnaires according to the orthopedic surgeons’ diagnosis, and related epidemiological and demographic data were further collected. The univariate analysis was used to screen the risk factors of hip fractures in the elderly, and the logistic regression model was established to conduct the multivariate analysis. Results Of the total 4,265 participants with clear information of hip fractures in elderly, 127 individuals with hip fractures were identified according to results of questionnaires, exhibiting a prevalence of 28.49 per 1,000 (95% confidence interval [CI]=21.38–35.60) for males and 31.03 per 1,000 (95% CI=23.72–38.35) for females. The mean age of the elderly with hip fractures was 77.12±5.88 years and tumble (48.0%) was the primary factor. In univariate analysis, age, race, smoking, drinking alcohol, and combined with osteoporosis were regarded as risk factors. Multivariate analysis showed that age (80 years and older), living alone, smoking, combined with diabetes and osteoporosis were the independent risk factors. Conclusion Our nationwide data indicate the prevalence of hip fractures in the elderly is generally on the rise, and the female occupies a higher proportion. Age (especially aged 80 years and older), race (mainly Non-Hispanic white), smoking, drinking alcohol, living alone, combined with diabetes and osteoporosis may be closely linked to the occurrence of hip fractures in the elderly, although these variables still need to be verified in further prospective investigations.

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“…Although the incidence of comorbidities in elderly IHF patients (pulmonary, cardiac and neurological diseases, hypertension, diabetes, etc.) can reach 80-95% (3,4,11,38), (40,41), some studies have reported that, regardless of the surgical treatment selected, pneumonia and heart failure cause significantly high rates of mortality (14,35,42). The results of our study suggest that four types of common comorbidities have a negligible prognostic influence on the survival rate, 1-year all-cause mortality rate, and hip function recovery at the last follow-up.…”

Section: Discussionmentioning

confidence: 46%

“…It is well believed that surgery should be performed as soon as the patient's medical condition allows if appropriate staff and facilities are available (46,47). Some studies have suggested that TFIS is closely related to the occurrence of complications and the clinical outcome (34,35,41,48). In this study, we further analyzed the impact of TFIS on overall survival in a Cox regression model, and the results showed no significant prognostic influence (P=0.69).…”

Section: Discussionmentioning

confidence: 82%

Predictive factors associated with the clinical outcome of intertrochanteric hip fracture in high-risk elderly patients treated with total hip arthroplasty versus percutaneous external fixation

et al. 2021

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Background: Little is known regarding the survival and functional recovery of elderly intertrochanteric hip fracture (IHF) patients after total hip arthroplasty (THA) versus percutaneous external fixation (PEF).This study aims to analyze the prognostic factors of THA and PEF in elderly IHF patients.Methods: A total of 155 consecutive elderly patients (mean age of 80 years) diagnosed with IHF were retrospectively reviewed from our database between January 1, 2010, and December 31, 2018. The preoperative, intraoperative and postoperative covariates were analyzed by two independent surgical cohorts: THA and PEF. The main outcomes included the hip function score, all-cause mortality within 1 year after surgery, and overall survival. Covariables and their influence on independent outcomes were analyzed using multivariate regression models. Results:The median follow-up period was 5.1 years, and 6 patients were lost to follow-up. At the endpoint, 70 of 85 patients treated with THA and 37 of 70 patients treated with PEF survived, exhibiting mean Harris hip scores of 84.4 and 69.0, respectively. The Kaplan-Meier curves and log-rank tests showed no significant difference in overall survival. After adjusting for the covariates, the surgical mode was a unique prognostic factor affecting hip function recovery, and two prognostic factors (leukocyte count and D-dimer) were correlated with 1-year all-cause mortality. Age at admission, fracture classification, D-dimer level and surgical mode were identified as prognostic factors affecting overall survival. After adjusting for the former three covariates, THA reduced the risk of death by 67.20% compared with PEF (HR 0.328, 95% CI, 0.121-0.890).Conclusions: Despite the nonsignificant difference in 1-year all-cause mortality, THA demonstrated superior midterm survival and hip function recovery in elderly IHF patients compared with PEF. Predictive factors, including age at admission, fracture classification, D-dimer level and surgical mode, are associated with the overall survival of IHF in high-risk elderly patients.

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Relationship between comorbidities and treatment decision-making in elderly hip fracture patients

Cited by 48 publications

References 33 publications

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

Prevalence, Characteristics, and Associated Risk Factors of the Elderly with Hip Fractures: A Cross-Sectional Analysis of NHANES 2005–2010

Predictive factors associated with the clinical outcome of intertrochanteric hip fracture in high-risk elderly patients treated with total hip arthroplasty versus percutaneous external fixation

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