Elderly Orthopaedic Patients Research Articles

Development and Validation of a Postoperative Delirium Prediction Model for Elderly Orthopedic Patients in the Intensive Care Unit.

We developed a prediction model for delirium in elderly patients in the intensive care unit who underwent orthopedic surgery and then temporally validated its predictive power in the same hospital. In the development stage, we designed a prospective cohort study, and 319 consecutive patients aged over 65 years from January 2018 to December 2019 were screened. Demographic characteristics and clinical variables were evaluated, and a final prediction model was developed using the multivariate logistic regression analysis. In the validation stage, 108 patients were included for temporal validation between January 2020 and June 2020. The effectiveness of the model was evaluated through discrimination and calibration. As a result, the prediction model contains seven risk factors (age, anesthesia method, score of mini-mental state examination, hypoxia, major hemorrhage, level of interleukin-6, and company of family members), which had an area under the receiver operating characteristics curve of 0.82 (95% confidence interval 0.76–0.88) and was stable after bootstrapping. The temporal validation resulted in an area under the curve of 0.80 (95% confidence interval 0.67–0.93). Our prediction model had excellent discrimination power in predicting postoperative delirium in elderly patients and could assist intensive care physicians with early prevention.

Effects of aging and elapse time on muscle fatty infiltration after rotator cuff tear in a mouse model

Rotator cuff tears are one of the most common injuries in elderly orthopedic patients, and massive rotator cuff tears are often associated with progressive and irreversible muscle degeneration. This study aimed to evaluate the effect of aging and elapsed time on muscle fatty infiltration after rotator cuff tear in young and aged mice.

Preoperative Delirium Nursing Model Initiatives to Determine the Incidence of Postoperative Delirium Among Elderly Orthopaedic Patients.

Delirium is a common neurocognitive disorder prevalent in hospitalized older adults. The development of delirium is associated with adverse health outcomes, including functional decline and mortality. This study aimed to investigate the incidence and risk factors of postoperative delirium in older adults (≥60 years) who underwent orthopaedic surgery. Elderly orthopaedic patients were recruited from a large urban hospital over 12 months. Patients were preoperatively screened for delirium and followed up at least once daily postoperatively until discharge. Of the 124 patients in the sample, 21 (16.9%) had postoperative delirium. There were no significant differences in any of the baseline characteristics between the delirious and nondelirious patients. Patients using antidepressants were more likely to develop postoperative delirium compared with those not using antidepressants (odds ratio: 2.72, p = .05). Postoperative delirium was common in this sample of older adults who underwent orthopaedic surgery. Aiming prevention strategies toward patients using antidepressants may help reduce the incidence of delirium in this population.

Frailty is an independent risk factor of one-year mortality after elective orthopedic surgery: a prospective cohort study.

Frailty is associated with perioperative adverse outcomes, especially for the elderly. This study aimed to assess whether frailty was an independent risk factor of one-year mortality in frail patients after elective orthopedic surgery. In this prospective study, three hundred and thirteen patients aged ≥ 65 years, undergoing elective orthopedic surgery were finally included. Frailty assessed by the Clinical Frailty Score (CFS) before the surgery was present in 29.7% (93/313). Among them, 7.7% of patients (24/313) died at one year after surgery. In multivariate logistic analysis, higher CFS (OR = 2.271, 95% CI= 1.472–3.504) was found to be an independent risk factor of one-year mortality after surgery in elderly orthopedic patients. The area under the receiver operating characteristic curve of the model was 0.897 (95% CI 0.834–0.959). In addition, we found higher Charlson comorbidity index (OR= 1.498, 95% CI = 1.082–2.073) was also a significant risk factor. In conclusion, frailty is associated with increased one-year mortality in elderly patients after elective orthopedic surgery, which should be considered as a routine assessment tool in preoperative practice.

Prediction of ICU admission after orthopedic surgery in elderly patients.

Objectives:Prediction of ICU admission after surgery are important for rational decision-making for different patients in clinical practice. Little information is available about the risk factors of postoperative ICU admission in elderly patients undergoing orthopedic surgery. This study aimed to identify risk factors and develop a predictive model for postoperative ICU admission in elderly patients undergoing orthopedic surgery.Methods:A total of 2826 cases of elderly patients receiving orthopedic surgery from October 2010 to September 2016 were retrospectively collected and analyzed. Logistic regression was used to evaluate the impacts of covariates. Support vector machine (SVM) was employed to develop a predictive model based on all pre-operative covariates and the demographic information.Results:There were 256 patients transferred to ICU after surgery. ASA III or IV and emergency surgery were found to be independent risk factors while neuraxial anesthesia and joint surgery were protective factors. In addition, a SVM-based predictive model was developed, which had a sensitivity of 90.99%, a specificity of 99.10% and an area under ROC curve of 0.9678.Conclusions:Our study revealed that emergency surgery, anesthesia method, surgery type and ASA grade were risk factors to predict postoperative ICU admission in elderly orthopedic patients.

Multi-Component Care Bundle in Geriatric Fracture Hip for Reducing Post-Operative Delirium.

Background:Delirium in elderly orthopaedic patients poses an enormous medical, social and financial burden to the healthcare system, and causes significant distress to patients and their caregivers. We examined whether a Multi-component Care Bundle (MCB) could reduce the incidence of post-operative delirium (POD) in fractured hip patients.Methods:An observational study was conducted, analyzing 154 patients (mean age ± SD, 85 ± 7.8, 68% women) admitted to Queen Mary Hospital with hip fracture. Half of the patients were cared for in the control group before MCB was introduced, which included installation of orientation aids, introduction of a Caregiver Empowerment Program, and incorporation of ultrasound-guided Fascia Iliaca Block (FIB) into the analgesia protocol.Results:There were fewer patients with POD in the MCB group, compared with the control group (18/76, 23.4% v 34/76, 44.2%, p = 0.006). Patients in MCB group consumed less opioid ( 4/77 v 13/77, p = 0.048), experienced less post-operative dizziness (2/77, 2.6% v 13/77, 16.9%, p = 0.003) and had a shorter median day to start walking post-operatively (day 1 [IQR 1-2] vs day 2 [IQR 2-3]; p = 0.001) than the control group. Length of stay was not affected.Conclusion:MCB effectively reduces POD, postoperative dizziness, opioid consumption, and days to start mobilization postoperatively.

Management and Model Study of Postoperative Pain in Elderly Orthopaedic Patients

Management and Model Study of Postoperative Pain in Elderly Orthopaedic Patients

Dental Health Status Among Elderly Orthopaedic Patients

Dental Health Status Among Elderly Orthopaedic Patients

Reply to: Direct oral anticoagulants and neuraxial block in elderly orthopedic patients: is it time to review guidelines?

Reply to: Direct oral anticoagulants and neuraxial block in elderly orthopedic patients: is it time to review guidelines?

Evaluation and role of prealbumin levels on postoperative stay in orthopaedic surgical patients

In this present research study we tried to evaluate whether serum Prealbumin levels would serve as a prognosticator of length of stay in hospital for elderly orthopaedic patients who have underwent hip replacement surgery. Our study consisted of a set of 54 patients admitted to a Malla Reddy Institute of Medical Sciences in the year 2014. After initial examinations all the patients were categorised with decreased Prealbumin levels, normal Prealbumin levels, or increased prealbumin levels were monitored during their stay in hospital. The physical parameters data was collected that includes: patients age, length of stay, blood glucose, hemoglobin, RBC, WBC, Prealbumin, and post-operative diet intake. The experimental data was analyzed using SPSS software and probabilities approaching p< 0.10 were considered and levels of p< 0.05 were deemed to be significant. Our research study shows a substantial and significant relationship between Prealbumin levels at admission and length of patient stay during post-operative recovery.

Qualitative Analysis of Elderly Orthopedic Patients’ Anxiety on the Occasion of Discharge after Bone and Joint Disease Surgery

Qualitative Analysis of Elderly Orthopedic Patients’ Anxiety on the Occasion of Discharge after Bone and Joint Disease Surgery

The influence of the infusion of ephedrine and phenylephrine on the hemodynamic stability after subarachnoid anesthesia in senior adults - a controlled randomized trial

BackgroundWe studied the influence of ephedrine or phenylephrine infusion administered immediately after spinal anesthesia (SA) on hemodynamics in elderly orthopedic patients.MethodsA prospective, randomized, double-blind, placebo-controlled study.After a subarachnoid injection of 15 mg of levobupivacaine, the participants received an infusion of either ephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 min. We measured blood pressure, cardiac index (CI) and heart rate (HR) from 15 min before to 30 min after SA.ResultsSeventy patients were included in the final analysis. At the end of measurements, mean arterial pressure (MAP) decreased significantly after SA in comparison to the baseline value in the C group but was maintained in the P and E group, with no significant differences between the groups. CI decreased after SA in the C group, was maintained in the P group, and increased significantly in the E group with significant differences between the C and E group (p = 0.049) also between the P and E (p = 0.01) group at the end of measurements. HR decreased significantly after SA in the C and P group but was maintained in the E group, with significant differences between the P and E group (p = 0.033) at the end of measurements.ConclusionsHemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine. In addition to maintaining blood pressure, the ephedrine infusion also maintains HR and increases CI after SA.Trial registrationISRCTN registry with registration number ISRCTN44377602, retrospectively registered on 15 June 2017.

Vitamin D Deficiency/Insufficiency Is Associated with Risk of Osteoporotic Thoracolumbar Junction Vertebral Fractures.

BackgroundThe association between serum vitamin D level and vertebral fracture (VFx) remains controversial. The purpose of this study was to determine whether serum 25-hydroxy vitamin D (25(OH)D) level is associated with osteoporotic thoracolumbar junction VFx in elderly patients.Material/MethodsFrom Jan 2013 to Dec 2017, this retrospective case-control study included 534 patients with primary osteoporotic thoracolumbar junction VFx (T10–L2) and 569 elderly orthopedic patients with back pain (without osteoporotic VFx) as controls. Serum 25(OH)D levels were measured and the association with osteoporotic VFx was analyzed. Other clinical data, including BMI, comorbidities, and bone mineral density (BMD), were also collected and compared between these 2 groups.ResultsIt was shown that 25(OH)D levels were significantly lower in patients with T10–L2 VFx than in control patients. Among 534 VFx patients, 417 (78.1%) patients showed grade 2–3 fracture. Serum 25(OH)D levels were significantly related to affected vertebral numbers and VFx severities. The VFx risk was 28% lower (OR=0.72, 95% CI 0.62–0.83) per increased SD in serum 25(OH)D. Compared with the 1st quartile (mean 25(OH)D: 29.67±6.18 nmol/L), the VFx risk was significantly lower in the 3rd (mean 25(OH)D: 60.91±5.12nmol/L) and 4th quartiles (mean 25(OH)D: 103.3±44.21nmol/L), but not in the 2nd quartile (mean 25(OH)D: 45.40±3.95 nmol/L). In contrast, the VFx risk was significantly increased in the 1st quartile (OR=1.87, 95% CI 1.42–2.45) compared with the 2nd–4th quartiles.ConclusionsVitamin D deficiency/insufficiency was associated with risk of osteoporotic thoracolumbar junction vertebral fractures in elderly patients.

Postoperative delirium prediction model for elderly patients undergoing orthopedic surgery

Objective To establish a preliminary model which can effectively predict the risk for postoperative delirium (POD) in elderly orthopedic patients and verify its effectiveness. Methods This prospective study involved 2 cohorts. For an analysis cohort, the assessment data of 148 elderly orthopedic patients were collected who had been treated at Department of Orthopaedics, the First Affiliated Hospital of Zhengzhou University from June to October 2017. The relevant risk factors for POD (gender, age, BMI, schooling < 9 years, history of smoking and alcohol drinking, concomitant diseases and perioperative factors) were screened after comparing POD and non-POD patients. All the risk factors were analyzed and a predictive model was established after valuation of independent risk factors. A predictive cohort of 66 patients was included according to the same inclusion and exclusion criteria as the analysis cohort out of the patients who had been treated at our hospital from November to December 2017. The 2 cohorts were scored by the predictive model to verify the validity of the model. Results A total of 18 risk factors were identified in this study. In the analysis cohort, age (P=0.006), schooling 75 years was assigned 3 points, schooling < 9 years 2 points and intraoperative infusion of allogeneic blood 5 points. The validity of the ROC curve was verified for the predictive model. According to the ROC curve, the analysis cohort had AUC=0.66 and the predictive cohort AUC=0.75, indicating a certain predictive value of the model. Conclusion Our predictive model can be used to effectively screen out those with a high risk for postoperative delirium from elderly orthopedic patients. Key words: Aged; Delirium; Forecasting; Orthopedic surgery; Effectiveness

Is primary prevention of Clostridioides difficile infection possible with combination probiotics in elderly orthopedic patients?

Is primary prevention of Clostridioides difficile infection possible with combination probiotics in elderly orthopedic patients?

Decreased Lean Psoas Cross-Sectional Area Is Associated With Increased 1-Year All-Cause Mortality in Male Elderly Orthopaedic Trauma Patients.

To investigate the association between lean psoas cross-sectional area (CSA) and 1-year all-cause mortality in elderly patients sustaining pelvic and long bone fractures. Retrospective cohort. Level I trauma center. Elderly trauma patients admitted from 2007 to 2014. We reviewed demographic and clinical data, injury mechanism, fracture OTA/AO classification, and mortality. Axial computed tomography images were used to measure lean psoas CSA at the L3-L4 disk space. Cox proportional hazard regression analysis was used to estimate 1-year mortality association with psoas CSA in crude and adjusted for age, body mass index, Injury Severity Score, medical comorbidities, and discharge destination in total population and stratified by sex. One-year all-cause mortality defined as death within 12 months from date of hospitalization. Five hundred fifty-eight patients (54% female, 46% male) were analyzed. The pelvis was most commonly fractured (37.81%). A statistically significant association was observed between decreased lean psoas CSA and 1-year mortality in total population {hazard ratio [HR] = 0.93 [95% confidence interval (CI) = 0.90-0.96], P < 0.0001}. Stratification by gender revealed a statistically significant mortality HR in male patients [HR = 0.89 (95% CI = 0.84-0.96), P = 0.002]. We did not find a statistically significant mortality HR in female patients [HR = 0.95 (95% CI = 0.89-1.01), P = 0.103]. In this cohort of elderly orthopaedic trauma patients, decreased lean psoas CSA was associated with increased 1-year all-cause mortality in total population and males. Further investigation of the association of sarcopenia with mortality in the elderly is warranted. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Energy and protein intake in 330 geriatric orthopaedic patients: Are the current nutrition guidelines applicable?

Elderly orthopaedic patients are potentially at a high nutritional risk. The reasons for this are numerous as i.e. reduced appetite, sensation of satiety after eating small amounts of food, multi-medication or immobility. This is in contrast to the increased energy and protein recommendations for geriatric orthopaedic patients. Oral intake during hospitalization of more than 1000 geriatric orthopaedic patients aged over 80, with or without fracture, was recorded, calculated and then compared to energy and protein requirements by clinical dietitians according to international guidelines. 330 patients were included in the sample of which 76.7% were female (n=253) and 23.3% male (n=77). The mean age was 87.4 (+/-4.7) years. Most patients (204=61.8%) had lived at home prior to hospital admission. 72 patients (21.8%) lived in a retirement home, 54 (16.4%) lived in a nursing home. 98.5% of the included patients were unable to cover their energy needs and 99% were unable to achieve their protein needs. Only five patients (1.5%) were able to achieve their energy needs and one single patient (0.3%) achieved his recommended protein intake. Orthogeriatric patients are at high risk of malnutrition. Very few of these patients were able to cover their estimated energy and protein needs through dietary intake. This suggests that there is a high need of dietetic interventions in this multimorbid elderly patient group. The aim of the nutritional therapy and its interventions should be its continuity, especially after hospital discharge so that long-term optimization of the nutritional status can occur. Future research should further investigate if current recommendations are applicable and the best way to achieve a better nutritional status in this population risk group.

Combination probiotics may prevent Clostridium difficile infection among elderly patients undergoing an orthopedic surgery.

The incidence of Clostridium difficile infection (CDI) is greater in elderly orthopedic patients. We conducted a retrospective case-control study by selecting elderly patients who underwent proximal femoral fracture surgery to investigate the effect of probiotics on CDI prevention. Cases were diagnosed with CDI by an enzyme-linked immunosorbent assay for C. difficile toxins using frozen stool specimens. The primary method of exposure was receipt of combination probiotics such as Streptococcus faecalis, Bacillus mesentericus, and Clostridium butyricum. The crude odds ratio between developing CDI and receiving combination probiotics was 0.074 (95% CI: 0.010–0.565; p=0.002). Adjunctive combination probiotics among elderly patients who undergo proximal femoral fracture surgery likely reduces the probability of CDI.

Perioperative glucose levels and the risk of cardiovascular disease after hip fracture surgery

Rationale: It is unknown if glucose levels are prognostic for developing cardiovascular disease in elderly orthopaedic patients. The purpose of the study was to investigate the association between admission glucose and cardiovascular events after hip fracture surgery.

Study protocol for a single-centre, prospective, non-blinded, randomised, 12-month, parallel-group superiority study to compare the efficacy of pharmacist intervention versus usual care for elderly patients hospitalised in orthopaedic wards

IntroductionGiven that polypharmacy and potentially inappropriate prescribing are common in elderly orthopaedic patients, pharmacist interventions to improve medication practices among this population are important. However, past studies have reported mixed...