From Frailty to Chronic Pain: Nutritional Status and Pain Trajectories After Hip Fracture in the Elderly.

Hip fractures in elderly patients are associated with a high mortality rate. Most deaths associated with hip fracture result from complications after surgery. Recent studies suggest that some inflammation biomarkers may be useful to estimate excess mortality. This study aimed to investigate the prognostic value of admission inflammation biomarkers in elderly patients with hip fracture. We reports on a retrospective study of elderly hip fracture patients admitted to a hospital in China between January 2015 and December 2019. A total of 1085 patients were included in the study, and their demographic and pre-operative characteristics were analyzed. The inflammation biomarkers included monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), and C-reactive protein (CRP) to albumin ratio (CAR). The predictive performance of NLR, MLR and CAR was assessed by receiver operating characteristics (ROC) curve analysis and the association between admission inflammation markers and mortality was evaluated by Cox proportional regression. The 30-day, 1-year, 2-year, and 4-year mortality were 1.6%, 11.5%, 21.4% and 48.9%, respectively. The optimal cut-off values of admission NLR, MLR and CAR for 1-year mortality were 7.28, 0.76, and 1.36. After adjusting the covariates, preoperative NLR ≥ 7.28 (HR = 1.419, 95% CI: 1.080-1.864, p = 0.012) were found to be only independent risk factors with 4-year all-cause mortality, the preoperative CAR ≥ 1.36 was independently associated with 1-year (HR = 1.700, 95% CI: 1.173-2.465, p = 0.005), 2 year (HR = 1.464, 95% CI: 1.107-1.936, p = 0.008), and 4-year (HR = 1.341, 95% CI: 1.057-1.700, p = 0.016) all-cause mortality, While age, CCI score, and low hemoglobin at admission were also risk factors for postoperative all-cause mortality. Admission CAR and NLR may be useful indicators for predicting the long-term mortality of elderly patients undergoing hip fracture surgery, and that more research is needed to validate these findings.

SP35 Transitional pain and prevention of pain chronification

Fall risk perception (FRP) plays a crucial role in preventing secondary falls in elderly patients undergoing hip fracture surgery. Different patient groups may perceive environmental fall risk differently, but current research on this is relatively limited. Analyzing the differences in environmental fall risk perception and influencing factors among different types of elderly patients undergoing hip fracture surgery can contribute to a deeper understanding of fall risk awareness. Using convenience sampling, 255 elderly patients hospitalized for hip fractures in the orthopedics department of a Grade A, Class II hospital in Hangzhou from April to July 2025 were selected as participants. Data were collected using a general information questionnaire, the FRP Questionnaire, the Dizziness Handicap Inventory, the Barthel Index, and the Physical Status Scale. Latent profile analysis was conducted using Mplus 8.3. Univariate analysis and multivariate logistic regression were performed using SPSS 26.0. This study included a total of 255 elderly patients who were hospitalized due to hip fracture surgery. The three-category model was determined to be the optimal solution (entropy = 0.802) with good classification accuracy and discrimination ability. The elderly patients with hip fractures in the three categories showed the most pronounced differences in environmental factors, while differences in personal activities and physical conditions were relatively small in comparison. Therefore, the three categories were named Low Environmental FRP group (n = 81, 31.76%), Medium Environmental FRP’ group (n = 96, 37.65%) and High Environmental FRP group (n = 78, 30.59%)。The average scores for the three types in terms of environmental factors were 15.51, 24.58 and 34.54. And statistically significant differences were found among the three patient groups in self-reported health status, fear of falling, environmental factor scores, overall fall risk perception score, vertigo handicap score, Barthel Index and physical function performance (P < 0.05). Using the Moderate Environmental FRP Type as the reference group, multinomial logistic regression revealed that poorer self-rated health (OR = 0.243, 95% CI: 0.123–0.481) and fear of falling (OR = 0.209, 95% CI: 0.100–0.438) were associated with a higher likelihood of belonging to the Low Environmental FRP Type. Conversely, better self-rated health (OR = 3.342, 95% CI: 1.578–7.075) and stronger fear of falling (OR = 5.090, 95% CI: 2.230–11.617) significantly increased the likelihood of being classified into the High Environmental FRP Type. Dizziness handicap, Barthel Index and physical performance were not independently associated with profile membership. The level of fall risk perception among elderly hip fracture patients was moderate overall and could be classified into distinct latent profiles with clear categorical characteristics. Clinical nursing staff can tailor interventions based on these heterogeneous profiles, providing precise targets to enhance the accuracy of patients’ fall risk perception and ultimately reduce the actual risk of falls. not applicable.

The objective of this study was to utilize meta-analysis to com-pare the impact of regional anesthesia (RA) versus general anesthesia (GA) on postoperative outcomes in elderly patients undergoing hip fracture surgery. Electronic databases (PubMed, Web of Science, Cochrane Library, and Embase) were searched for randomized controlled trials (RCTs) comparing the effects of RA and GA in elderly patients undergoing hip fracture surgery. The random or fixed-effects model was used to calculate pooled relative risks (RR) and mean differences (MD). Fourteen RCTs involving 5626 elderly patients undergoing hip fracture surgery were included. Meta-analysis indicated that RA was associ-ated with a lower incidence of intraoperative blood loss (MD: -39.7 mL; 95% CI: -68.61, -10.84; p = 0.007), adverse events including intraoperative hypotension (RR: 1.09; 95% CI: 0.90, 1.32; p = 0.005) and postoperative cognitive dysfunc-tion (RR: 0.56; 95% CI: 0.37, 0.86; p = 0.007) compared to GA. However, no statistically significant differences were found between RA and GA regarding surgical time, anesthesia time, intraoperative transfusion, hospital length, de-lirium, and mortality. RA can effectively reduce intraoperative blood loss and the risk of hypotension. Due to the current lack of evidence, no positive effects of RA on other postoperative outcomes were identified. A rigorously designed, high-quality study is warranted to determine the impact of anesthesia type on elderly hip fracture patients.

Background: Hip fractures in elderly patients are a significant health-care concern due to their high morbidity and mortality rates. Aims and Objectives: This study aims to analyze post-operative complications in this demographic to improve care strategies. Materials and Methods: This observational study included 100 patients aged between 65 and 90 years, undergoing hip fracture surgery. The cohort comprised 40% males and 60% females. Patients underwent either total hip replacement (30%) or internal fixation (70%). We tracked post-operative complications within the first 30 days, mortality and reoperation rates, and recovery and rehabilitation outcomes over 6 months. Results: Post-operative complications were reported in several categories: Infection (10%), cardiovascular (15%), respiratory (12%), renal (5%), neurological (8%), and gastrointestinal (6%). The most common infections were superficial wound infections (6%) and deep infections (4%). Cardiovascular complications included arrhythmias (8%), myocardial infarction (4%), and venous thromboembolism (3%). Pneumonia (7%), acute respiratory distress syndrome (3%), and pulmonary embolism (2%) were the primary respiratory complications. The study also recorded a 4% 30-day mortality rate and a 7% reoperation rate. The average hospital stay was 7 days, with 60% of patients requiring post-discharge rehabilitation. At 6-month post-surgery, 70% of patients had achieved complete recovery. Conclusion: The study highlights a significant incidence of post-operative complications among elderly patients undergoing hip fracture surgery. The findings underscore the need for comprehensive perioperative care and vigilant monitoring to mitigate these risks. The data also stress the importance of post-discharge rehabilitation in enhancing recovery outcomes.

Hip fractures in the elderly have a significant impact, both in terms of human suffering and healthcare costs. Little is known about preoperative markers that may predict mortality following geriatric hip fracture surgery. This study aimed to investigate potential risk factors, including the C-reactive protein to albumin ratio (CAR), for mortality in elderly patients undergoing surgery for hip fracture. A total of 180 elderly patients with hip fractures were included in this cross-sectional study. The patients were divided into two groups: the survival group and the deceased group. Serum levels of C-reactive protein (CRP) and albumin, as well as the CAR, were compared between the two groups to determine whether CAR is a predictor of mortality in elderly patients undergoing hip fracture surgery. The Mini Nutritional Assessment-Short Form was used to evaluate the nutrition status of the patients. The mean age of the 180 participants was 78 years, and 53.3% were female. A statistically significant difference was observed between the two groups in terms of the duration of hospital and intensive care unit stay (p<0.05). According to the receiver operating characteristic (ROC) analysis, with a cutoff value of >0.15, CAR could predict mortality after geriatric hip fracture surgery with a sensitivity of 74% and a specificity of 53%. The area under the ROC curve (AUC) for CAR was 0.67 (95% confidence interval [CI]: 0.57-0.76, p<0.001). CAR and the time between fracture and surgery were found to be independent predictors of mortality (p=0.003, odds ratio [OR]=1.37 and p=0.044, OR=1.33, respectively). An elevated preoperative CAR is associated with a significantly increased risk of mortality in elderly patients undergoing hip fracture surgery. Additionally, a shorter time to surgery was associated with lower mortality in these patients.

ObjectivesPerioperative blood transfusion in elderly patients is associated with various complications. This study aimed to develop a clinical prediction model for intraoperative blood transfusion in elderly patients undergoing hip fracture surgery to minimize transfusion requirements and related risks.MethodPatients who underwent hip surgery between January 2021 and December 2023 at Xiangyang Central Hospital (Hubei, China) were retrospectively included in this study. Relevant factors for postoperative blood transfusion were analyzed using univariate and multivariate logistic regression analysis. A nomogram was established with the identified relevant factors, and its performance was evaluated using the area under the subject operating characteristic curve, calibration curve, and decision curve analysis.ResultA total of 1092 patients were included in this study for evaluation. Through logistic regression analysis, we identified surgery type, preoperative hemoglobin level, platelet count, osteoporosis, and cerebrovascular disease as relevant factors for postoperative blood transfusion. The nomogram was established, and the areas under the curve of the subjects’ work characteristics were found to be 0.730 (95% confidence interval [CI]: 0.686–0.773) and 0.726 (95% CI: 0.671–0.781) for the training and test sets, respectively.ConclusionIn this study, we identified surgery type, preoperative hemoglobin level, platelet count, osteoporosis, and cerebrovascular disease as the risk factors for postoperative blood transfusion in elderly hip fracture patients. The nomogram, established based on these risk factors, showed an acceptable discriminative ability to predict intraoperative blood transfusion in elderly patients during hip fracture surgery.Trial registrationThis clinical trial was registered at http://www.chictr.org.cn/ (ChiCTR2400085204, June 03, 2024).

AimThe purpose of this study was to examine the incidence and cause of unplanned readmission after Surgically Treated Hip Fractures in Elderly Patients and identify the associated risk factors.MethodsThis study retrospectively collected the data on elderly patients who underwent hip fracture surgery at two institutions from January 2020 to December 2021, and identified those who were readmitted within 12 months postoperatively. Based on the presence or not of postoperative readmission, they were divided into readmission and non-readmission groups. Demographics, surgery-related variables, and laboratory parameters were compared between groups. The specific causes for documented readmission were collected and summarized. Multivariate logistic regression analysis was performed to identify the associated risk factors.ResultsThere were 930 patients including 76 (8.2%) patients who were readmitted within 12 months postoperatively. Overall, cardiac and respiratory complications and new-onset fractures were the first three common causes of readmission, taking an overwhelming proportion of 53.9% (41/76). Over 60% (61.8%, 47/76) of readmissions occurred within 30 days after surgery, with medical complications taking a predominance (89.4%, 42/47). New-onset fractures accounted for a proportion of 18.4% (14/76), occurring at different time points; especially, at 90–365 days, it accounted for 44.4% (8/18). Multivariate analysis revealed that age ≥80 years (OR, 1.0, 95% CI, 1.0 to 1.1; P=0.032), preoperative albumin level ≤21.5 g/L (OR, 1.1, 95% CI, 1.0 to 1.2; P=0.009), the postoperative occurrence of DVT (OR, 4.2, 95% CI, 2.5 to 7.2; P=0.001), and local anesthesia (OR, 2.1, 95% CI, 1.1 to 4.0; P=0.029) were independent risk factors for unplanned readmissions.ConclusionThis study identified several risk factors for unplanned readmissions after elderly hip fractures, and provided detailed information about unplanned readmissions.

BackgroundDepression is a prevalent perioperative psychiatric complication among elderly hip fracture patients. Esketamine has rapid and robust antidepressant effects. However, it is unknown whether it can alleviate depressive symptoms in elderly patients who undergo hip fracture surgery. This study aimed to explore whether the adjunctive esketamine in patient-controlled intravenous analgesia (PCIA) could improve depressive symptoms in elderly patients undergoing hip fracture surgery.MethodsA single-center, prospective, double-blind and randomized controlled clinical trial was carried out from July 2022 to August 2023 at the Wenzhou People’s Hospital among 90 patients, aged ≥ 65 years with hip fracture undergoing elective surgery. Participants were randomly allocated to either the esketamine group (group S) or the control group (group C). In Group S, patients were administered 0.5 mg/kg of esketamine as a PCIA adjuvant for 48 h, while the control group received saline. The primary outcome was the assessment of depressive symptoms using the Geriatric Depression Scale-15 (GDS-15) on postoperative day 2. The secondary outcomes were assessments of depressive symptoms on postoperative day 7 and postoperative day 30, serum levels of brain-derived neurotrophic factor (BDNF) and 5-hydroxytryptamine (5-HT), postoperative pain intensity, the number of effective PCIA presses, sufentanil consumption, and adverse events.ResultsThe prevalence and GDS-15 scores of depression were significantly lower in group S on postoperative day 2 (28.6% vs. 53.5%; 3.5 ± 1.8 vs. 4.3 ± 1.7, P < 0.05). In group S, the number of effective PCIA presses was significantly lower on postoperative day 2 than that in group C [2(1–4) vs. 1(0–2), P<0.05]. Higher levels of BDNF (23.8 ± 1.7 ng/mL vs. 25.3 ± 2.0 ng/mL, P < 0.05) and 5-HT (219.5 ± 19.5 ng/mL vs. 217.0 ± 22.2 ng/mL, P < 0.05) in the blood were observed on postoperative day 2 in group S.ConclusionIn elderly patients aged ≥ 65 years undergoing hip fracture surgery, the administration of adjunctive esketamine in PCIA could improve depressive symptoms and increase levels of BDNF and 5-HT in the blood.Trial registrationChinese Clinical Trial Registry, ChiCTR2200061956 (Date: 13/07/2022).

To compare the effects of general anesthesia (GA) and spinal anesthesia (SA) on postoperative delirium (POD) in elderly patients undergoing hip fracture surgery and to identify associated risk factors. A retrospective study was conducted on 186 elderly patients who underwent hip fracture surgery at the Affiliated Hospital of Gansu University of Chinese Medicine from January 2021 to January 2023. Patients were categorized into GA and SA groups. The incidence of POD, postoperative pain control, and cognitive function changes were compared. Univariate and multivariate Logistic regression analyses were performed to identify independent risk factors for POD. The predictive value of significant factors was assessed using receiver operating characteristic (ROC) curve analysis. The incidence of POD was significantly higher in the GA group than that in the SA group (27.4% vs. 9.9%, P=0.002). The visual analogue scale scores at 24 hours postoperatively and analgesic drug usage were significantly higher in the GA group (both P<0.001). Cognitive function scores postoperatively were significantly lower in the GA group (P<0.005). Multivariate analysis identified longer operation time (P<0.001, OR: 1.084, 95% CI: 1.047-1.123) and higher intraoperative blood loss (P=0.042, OR: 1.018, 95% CI: 1.001-1.035) as independent risk factors for POD. Conversely, higher preoperative hemoglobin (P=0.002, OR: 0.949, 95% CI: 0.919-0.981) and SA (P=0.021, OR: 0.174, 95% CI: 0.039-0.767) were protective factors. Compared to GA, SA significantly reduces POD incidence and improves postoperative analgesia in elderly hip fracture patients. Optimizing anesthetic strategies and preoperative assessments may enhance postoperative recovery in this population.

Vitamin D deficiency can lead to osteoporosis and increases the risk of fractures. Vitamin D deficiency is prevalent in Asian populations, however, research focusing on the association between vitamin D deficiency and osteoporotic hip fractures, particularly in Chinese populations is scarce. The aim of this study was to explore the relationship between vitamin D deficiency and osteoporotic hip fractures in elderly Chinese patients. This cross-sectional study recruited 60 patients (aged 65 years and over) who had hip fractures. Serum 25-hydroxyvitamin D (25OHD) levels were examined using an electrochemiluminescence immunoassay. The patients were classified into two groups based on their bone mineral density (BMD); subjects with osteoporosis (BMD t value ≤-2.5) and individuals without osteoporosis (BMD t value ≥-1.0). Serum 25OHD was further analyzed in these two groups. Across all of the patients with hip fractures, approximately 10% showed vitamin D deficiency, and a further 53.33% showed vitamin D. insufficiency. Furthermore, of the patients with hip fractures, those with osteoporosis had significantly lower levels of serum 25OHD (25.43±6.35 ng/mL) compared to those patients without osteoporosis (30.70±7.17 ng/mL). The incidence of vitamin D insufficiency (66.67%) and deficiency (16.67%) was higher in the patients with osteoporosis than in those without osteoporosis (insufficiency 44.44% and deficiency 5.56%, respectively). Our study confirmed a high prevalence of vitamin D insufficiency in elderly patients with hip fractures in China. Our data suggests that vitamin D plays an important role in the occurrence of hip fractures in these elderly patients, and especially where patients also suffer from osteoporosis.

Malnutrition in general and protein deficiency in particular, both upon admission and during the recovery period, may adversely influence the clinical outcome after hip fracture. This study investigates the relationship between nutritional status measured by the Mini-Nutritional Assessment short form (MNA-SF) and biological markers in elderly hip-fractured patients. A prospective study in a university hospital. The MNA-SF nutritional scale and laboratory values (serum albumin, cholesterol, total lymphocyte count) were assessed within three days after hip fracture surgery. Seventy-three patients were included: 61 (84%) were women and 12 men. Mean age was 81.5+/-7.1 years. Inhospital mortality was 10%. The mean MNA-SF score was 11+/-0.5 (range 3-14); according to these values, 39 patients (53%) were at risk of malnutrition. MNA-SF scores were not significantly correlated to patients' laboratory values. Fourteen episodes of nosocomial infection were diagnosed in 11 patients, and 6 patients developed pressure ulcers during hospitalization. MNA-SF test scale values reflect a clinical process in post-operative hip-fractured patients which is different from serum albumin, cholesterol or lymphocyte count.

Purpose We sought to identify preoperative cardiac abnormalities associated with postoperative mortality in elderly patients undergoing hip fractures surgery, in order to provide reference for focused transthoracic echocardiography (TTE). Methods In this retrospective study, a total of 669 elderly patients (age over 65 years) undergoing hip fractures surgery were included, of which 58(8.7%) died within one-year after discharge. Cox regression analysis models were used to identify the prognostic cardiac abnormalities of postoperative mortality. Results Univariate analysis showed that age (HR 1.065, 95%CI 1.030–1.101; P &lt; 0.001), ASA score (III, IV vs. I, II) (HR 1.855, 95%CI 1.098–3.067; P = 0.022), history of chronic obstructive pulmonary disease (COPD)(HR 4.446, 95%CI 1.909–10.355; P = 0.001) and atrial fibrillation (AF)(HR 3.803, 95%CI 1.803–8.024; P &lt; 0.001), presence of left ventricular ejection fraction (LVEF) &lt; 50%(HR 5.009, 95%CI 2.151–11.665; P &lt; 0.001), left ventricular dilatation (HR 3.813, 95%CI 1.730–8.403; P = 0.001), pulmonary arterial systolic pressure (PASP) &gt; 25mmHg(HR 4.388, 95%CI 2.492–7.725; P &lt; 0.001), moderate-severe aortic valve stenosis (AS) (HR 4.702, 95%CI 1.471–15.035; P = 0.009) were the dominant predictors of mortality within one-year. The presence of LVEF &lt; 50%, left ventricular dilatation and elevated PASP were proved to be the independent predictors of one-year mortality in elderly patients in multivariate analysis. Conclusion Cardiac abnormalities derived from preoperative TTE, namely LVEF &lt; 50%, AS, left ventricular dilatation and elevated PASP had prognostic value for elderly patients undergoing hip fracture surgery. We consider that these indices would be clinically important regarding the preoperative cardiac risk assessment of elderly hip fracture patients who are treated with surgery, which may be assessed in the focused TTE.

Hip fractures in the elderly are frequently associated with complications and unfavorable outcomes. Managing postoperative delirium, pain, sleep disturbances, and overall quality of life presents significant challenges in clinical care. This study aimed to explore the effectiveness of refined nursing interventions in improving postoperative recovery and patient satisfaction among elderly patients undergoing hip fracture surgery. A retrospective analysis was conducted on 252 elderly patients with surgically treated hip fractures admitted to Zhejiang Provincial People’s Hospital and Tongxiang First People’s Hospital between January 2021 and June 2024. To minimize selection bias, participants were allocated into 2 groups using propensity score matching, ensuring comparable baseline characteristics between the groups. The observation group (n = 126) received refined nursing care tailored to individual needs, while the control group (n = 126) received standard nursing care. Key outcomes assessed included the incidence and duration of postoperative delirium, hospital length of stay, pain intensity (visual analog scale), sleep quality (Pittsburgh Sleep Quality Index), quality of life (SF-36), recovery quality (the quality of recovery-40), and satisfaction with nursing care. Compared to the control group, patients in the observation group showed a marked reduction in both the incidence and duration of postoperative delirium. They also experienced shorter hospital stays and reported lower pain scores by the third postoperative day. Sleep quality was notably better on the first and third days following surgery. Moreover, assessments at 1 and 2 months postoperatively revealed significantly higher scores in both quality of life and recovery. Nursing satisfaction was also significantly enhanced in the refined care group (P < .05 for all comparisons). Refined nursing interventions, with a focus on personalized, comprehensive care strategies, significantly improve postoperative outcomes in elderly patients with hip fractures. These measures not only mitigate delirium and pain but also promote better sleep, faster recovery, improved life quality, and greater patient satisfaction, demonstrating meaningful clinical application.

BackgroundDysphagia is prevalent in geriatric patients, such as elderly hip fracture patients, and is associated with a poor prognosis. This study investigated (1) the prevalence of dysphagia based on clinical screening and a video-fluoroscopic swallowing study (VFSS), (2) the risk factors of dysphagia, and (3) the prognostic implications of dysphagia in elderly patients (≥ 65 years) undergoing hip fracture surgery.MethodsIn this retrospective study, data from 393 female and 153 male patients ≥65 years of age who underwent surgery for a hip fracture between 2015 and 2018 were analysed. Patients who were considered at high risk of dysphagia after screening underwent a VFSS. To identify risk factors of dysphagia, demographic factors, the American Society of Anesthesiologists classification, past medical history, known risk factors of dysphagia, and factors associated with surgery were analysed using a binary logistic regression model. Odds ratios (ORs) of dysphagia for having poor prognosis including postoperative pneumonia, intensive care unit (ICU) admission, and death within 6 months after surgery were obtained by logistic regression. The association of postoperative pneumonia with poor prognosis was also analysed.ResultsDysphagia was seen in 5.3% of hip fracture patients. In multivariate regression analysis, a serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia (OR [95%CI] = 3.13 [1.40, 7.01]). Dysphagia was identified as a risk factor for postoperative pneumonia in regression analysis after adjustment (OR [95%CI] = 3.12 [1.05, 9.27]). Postoperative pneumonia was significantly associated with ICU admission (OR [95% CI] = 4.56 [1.85, 11.28]) and death within 6 months after surgery (OR [95% CI] = 2.56 [1.03, 6.33]).ConclusionsDysphagia in elderly hip fracture surgery patients was associated with postoperative pneumonia, a risk factor for poor outcomes including ICU admission and death within 6 months after surgery. A serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia. Therefore, diagnostic testing should be performed to detect dysphagia, especially in patients with a low serum albumin level. Finally, particular care should be taken to prevent postoperative complications in patients with dysphagia.