Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2)

White, Stuart; Moppett, I. K.; Griffiths, R.; Johansen, Antony; Wakeman, R.; Boulton, Chris; Plant, F; Williams, Allison; Pappenheim, K.; Majeed, Ammar; Currie, Colin; Grocott, Michael P.W.

doi:10.1111/anae.13415

Cited by 143 publications

(161 citation statements)

References 34 publications

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“…Patients arriving in theatre with urinary evidence of ‘dehydration’ [49] also have a worse outcome. Hypotension, relative or absolute, is very common intra-operatively, both with spinal and general anaesthesia [50]. …”

Section: Discussionmentioning

confidence: 99%

Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury

et al. 2017

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BackgroundHip fracture is a common injury in older people with a high rate of postoperative morbidity and mortality. This patient group is also at high risk of acute kidney injury (AKI) and chronic kidney disease (CKD), but little is known of the impact of kidney disease on outcome following hip fracture.MethodsAn observational cohort of consecutive patients with hip fracture in a large UK secondary care hospital. Predictive modelling of outcomes using development and validation datasets. Inclusion: all patients admitted with hip fracture with sufficient serum creatinine measurements to define acute kidney injury. Main outcome measures – development of acute kidney injury during admission; mortality (in hospital, 30-365 day and to follow-up); length of hospital stay.ResultsData were available for 2848 / 2959 consecutive admissions from 2007-2011; 776 (27.2%) male. Acute kidney injury occurs in 24%; development of acute kidney injury is independently associated with male sex (OR 1.48 (1.21 to 1.80), premorbid chronic kidney disease stage 3B or worse (OR 1.52 (1.19 to 1.93)), age (OR 3.4 (2.29 to 5.2) for >85 years) and greater than one major co-morbidities (OR 1.61 (1.34 to 1.93)). Acute kidney injury of any stage is associated with an increased hazard of death, and increased length of stay (Acute kidney injury: 19.1 (IQR 13 to 31) days; no acute kidney injury 15 (11 to 23) days). A simplified predictive model containing Age, CKD stage (3B-5), two or more comorbidities, and male sex had an area under the ROC curve of 0.63 (0.60 to 0.67).ConclusionsAcute kidney injury following hip fracture is common and associated with worse outcome and greater hospital length of stay. With the number of people experiencing hip fracture predicted to rise, recognition of risk factors and optimal perioperative management of acute kidney injury will become even more important.

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Section: Discussionmentioning

confidence: 99%

Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury

et al. 2017

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“…Additionally, a forward searching in google scholar, a level one reference list searching and a formal searching of trial registries (https://clinicaltrials.gov/; www.who.int/ictrp/en/ (international clinical trials registry platform) Search Portal of the World Health Organization) was performed. The results of the study of White and colleagues for the hospital length of stay was provided by one of the Co- authors [26]. …”

Section: Methodsmentioning

confidence: 99%

General vs. neuraxial anaesthesia in hip fracture patients: a systematic review and meta-analysis

et al. 2017

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BackgroundHip fracture is a trauma of the elderly. The worldwide number of patients in need of surgery after hip fracture will increase in the coming years. The 30-day mortality ranges between 4 and 14%. Patients’ outcome may be improved by anaesthesia technique (general vs. neuraxial anaesthesia). There is a dearth of evidence from randomised studies regarding to the optimal anaesthesia technique. However, several large non-randomised studies addressing this question have been published from the onset of 2010.MethodsTo compare the 30-day mortality rate, in-hospital mortality rate and length of hospital stay after neuraxial (epidural/spinal) or general anaesthesia in hip fracture patients (≥ 18 years old) we prepared a systematic review and meta-analysis. A systematic search for appropriate retrospective observational and prospective randomised studies in Embase and PubMed databases was performed in the time-period from 01.01.2010 to 21.11.2016. Additionally a forward searching in google scholar, a level one reference list searching and a formal searching of trial registries was performed.ResultsTwenty retrospective observational and three prospective randomised controlled studies were included. There was no difference in the 30-day mortality [OR 0.99; 95% CI (0.94 to 1.04), p = 0.60] between the general and the neuraxial anaesthesia group. The in-hospital mortality [OR 0.85; 95% CI (0.76 to 0.95), p = 0.004] and the length of hospital stay were significantly shorter in the neuraxial anaesthesia group [MD -0.26; 95% CI (−0.36 to −0.17); p < 0.00001].ConclusionNeuraxial anaesthesia is associated with a reduced in-hospital mortality and length of hospitalisation. However, type of anaesthesia did not influence the 30-day mortality. In future there is a need for large randomised studies to examine the association between the type of anaesthesia, post-operative complications and mortality.

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“…Conversely, general anaesthesia may be associated with a more stable hemodynamic state than regional anaesthesia. However, when regional anaesthesia is administered, clinicians must be aware of the hypotensive effects because intraoperative hypotension leads to critical organ hypoperfusion and postoperative ischemic complications including delirium, dysthymia, and acute kidney injury, which are independently associated with poor outcomes (14).…”

Section: Discussionmentioning

confidence: 99%

Headache Characteristics in Geriatric Age Group According to Ichd-3 Beta Version

yıldırım¹

2018

tjgeri

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Introduction:Femoral fracture is associated with high geriatric mortality. Frailty is the increased vulnerability to stressors resulting from aging-associated decreases in physiological reserve. We aimed to predict 30-365-day postoperative mortality and morbidity rates using modified frailty index and perioperative characteristics in geriatric femoral fractures.Materials and Method: Using a prospective observational design, data were collected from patients >65 years undergoing femoral fracture surgery from 13 different hospitals in 2016 and 2017. Post-discharge follow-up periods were 30, 90, 180, and 365 days. Age, sex, modified frailty index and anaesthesia types used during surgery were recorded. Renal markers, troponin I and haemoglobin levels were examined preoperatively and postoperatively at 24 and 72 hours.Results: We included 392 patients in this study. The age of the patients were between 65 and 101 (mean, 79±11.9). Median modified frailty index was 5 (interquartile range, 2-7). Increase in modified frailty index increased mortality rate. Mortality rate at postoperative 30 days was 9.8%, while overall study mortality rate was 23%. Spinal anaesthesia was administered in 205 patients (52.3%, most frequent), followed by general in 110 (28.1%), peripheral nerve blocks in 21 (5.4) and spinal-epidural in 43 (11%). Anaesthesia type affected both intensive care unit (p<0.001) and total hospitalization (p<0.012) duration. A logistic regression model revealed that frailty index, preoperative creatinine and centre type were independent mortality predictors.Conclusion: Increased modified frailty index was associated with higher postoperative mortality risk, thus providing an additional way for improving risk stratification. Preoperative creatinine increase and centre types are determining factors in mortality.Keywords: Frail elderly; Geriatrics; Femoral fractures; Anesthesia; Mortality; Morbidity Giriş: Femur kırığı geriatrik popülasyonda yüksek mortalite ile ilişkili ciddi bir durumdur. Kırılganlık, yaşlanmayla ilişkili fizyolojik rezerv azalmalarından kaynaklanan savunmasızlığın klinik olarak artmasıdır. Bu çalışmada geriatrik femur kırığı ameliyatı sonrası 30-365 günlük postoperatif mortalite ve morbidite oranlarını, modifiye kırılganlık indeksi ve perioperatif özellikleri kullanarak öngörmeyi amaçladık.Gereç ve Yöntem: Prospektif, gözlemsel, çok merkezli çalışmada, 2016 ve 2017 yıllarında 13 farklı hastaneden femur kırığı ameliyatı geçiren 65 yaş üstü hastalardan veri toplandı. Taburculuk sonrası belirlenen izlem aralıkları 30, 90, 180 ve 365 gündü. Yaş, cinsiyet, mFİ ve uygulanan anestezi yöntemi kaydedildi. Böbrek belirteçleri, troponin I ve hemoglobin düzeyleri preoperatif ve postoperatif 24 ve 72. saatlerde incelendi.Bulgular: Araştırmaya 392 hasta dahil edildi. Hastaların yaşları 65-101 yıl idi (ortalama 79±11.9). Medyan modifiye kırılganlık indeksi 5 (interquartile range, 2-7) idi. 7); ve artışı ile mortalite oranını yükseldi. Postoperatif 30 günlük mortalite hızı %9.8 iken genel mortalite %23 bulundu. E...

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Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2)

Cited by 143 publications

References 34 publications

Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury

Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury

General vs. neuraxial anaesthesia in hip fracture patients: a systematic review and meta-analysis

Headache Characteristics in Geriatric Age Group According to Ichd-3 Beta Version

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