Risk Prediction in Operatively Treated Fractures of the Hip

Miller, Karl; Atzenhofer, Karl; Gerber, Gwendolyn L.; Reichel, Martina

doi:10.1097/00003086-199308000-00019

Cited by 27 publications

(11 citation statements)

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“…Our overall complication rate was higher (38%) than previous reports by others. 19,[23][24][25][26] Thus, Lawrence et al, 19 in their retrospective study of 20 facilities, demonstrated an overall complication rate of 17%, even though they also included postoperative cardiac complications. Although their study period overlapped our own (1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993), they additionally included patients aged 60 to 65 years, a population known to have fewer comorbidities and fewer postoperative complications than the elderly hip-fracture patients studied here.…”

Section: Discussionmentioning

confidence: 99%

Body mass index (BMI) and risk of noncardiac postoperative medical complications in elderly hip fracture patients: A population‐based study

Batsis

Huddleston

Melton

et al. 2009

Journal of Hospital Medicine

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Background Obese patients are thought to be at higher risk of post-operative medical complications. We sought to determine whether body mass index (BMI) is associated with post-operative in-hospital non-cardiac complications following urgent hip fracture repair. Methods We conducted a population-based study of Olmsted County, Minnesota residents operated for hip fracture in 1988–2002. BMI was categorized as underweight (<18.5kg/m2), normal (18.5–24.9kg/m2), overweight (25.0–29.9kg/m2) and obese (≥30kg/m2). Post-operative inpatient non-cardiac medical complications were assessed. Complication rates were estimated for each BMI category and overall complication rates were assessed using logistic regression models adjusted for age, sex, calendar year, and American Society of Anesthesia (ASA) class. Results There were 184 (15.6%) underweight, 640 (54.2%) normal, 251 (21.3%) overweight, and 105 (8.9%) obese hip fracture repairs (mean age, 84.2±7.5 years; 80% female). No significant difference was found among the BMI categories for baseline ASA status (ASA III–IV vs. I–II; p=0.14). After adjustment, the risk of developing an inpatient non-cardiac complication for each BMI category, compared to normal BMI, was: underweight (OR 1.33; 95%CI: 0.95–1.88; p=0.10), overweight (OR 1.01;95%CI: 0.74–1.38; p=0.95), and obese (OR 1.28;95%CI: 0.82–1.98; p=0.27). Multivariate analysis using stepwise selection demonstrated that an ASA status of III–V vs. I–II(OR 1.84, 95%CI: 1.25–2.71; p=0.002), a history of chronic obstructive pulmonary disease or asthma (OR 1.58; 95%CI: 1.18–2.12; p=0.002), male sex (OR 1.49, 95%CI:1.10–2.02; p=0.01) and older age (OR 1.05;95%CI: 1.03–1.06; p<0.001), significantly contributed to an increased risk of developing a post-operative non-cardiac inpatient complication. Underweight patients had higher in-hospital mortality rates than normal BMI patients (9.3 vs. 4.4%; p=0.01). Conclusions BMI has no significant influence on post-operative non-cardiac medical complications in hip fracture patients. These results attenuate concerns that obese or frail underweight hip fracture patients may be at higher risk post-operatively for inpatient complications.

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Section: Discussionmentioning

confidence: 99%

Body mass index (BMI) and risk of noncardiac postoperative medical complications in elderly hip fracture patients: A population‐based study

Batsis

Huddleston

Melton

et al. 2009

Journal of Hospital Medicine

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“…To describe clinical variables that may increase the risk of complications, we reviewed the literature of preoperative risk indices and guidelines and identified 11 categories of physical and laboratory findings commonly used to determine risk of proceeding with surgery. [1][2][3][4][5][19][20][21][22] We tabulated the most commonly used criteria. For example, we presented the items and cutoff values (e.g., pO 2 o60 mmHg) from the cardiac risk index.…”

Section: Methodsmentioning

confidence: 99%

Preoperative status and risk of complications in patients with hip fracture

et al. 2006

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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.

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“…Few recent studies with at least 100 patients have reported specific medical complications after hip fracture repair. 29,41,42,46,48 Among these, incidence was 7% for cardiac complications, 12% for cardiac failure (one study, 317 patients), and 6% to 10% for pneumonia (3 studies, 100-317 patients). 29,41,42,48 Rates from our study are similar but somewhat lower for serious pulmonary and cardiac complications.…”

Section: Commentmentioning

confidence: 99%