Geriatric Hip Fracture Patients Research Articles

How to predict postoperative delirium in geriatric patients with hip fracture as soon as possible? A retrospective study

PurposeInflammation may play a role in the mechanism of postoperative delirium (POD), a severe complication among older postoperative patients. The purpose of this study was to investigate the risk factors of POD in postoperative patients with hip fracture, especially the inflammation marker– neutrophil–lymphocyte ratio (NLR).MethodsThis retrospective investigation utilized data from the Seventh Medical Center of People’s Liberation Army. 1,242 Eligible patients with hip fracture (829 females), median age 81 years, mean neutrophil-lymphocyte ratio (NLR) 5.28, were enrolled. Receiver operating characteristic (ROC) curve was performed to identify the optimal cut point of NLR for POD. The relationship between NLR and POD occurrence, NLR and POD duration were analyzed by multivariable analysis.ResultsROC curve showed that the optimal cut point of NLR for POD was NLR ≥ 7.6. Multivariate logistic regression analysis showed that NLR ≥ 7.6 (odds ratio [OR] 2.75, [95% confidence interval [CI] 1.51 to 5.02], p = 0.001), stroke (OR 1.05, [95% CI 1.02 to 1.09], p = 0.005), complications, general anesthesia, long length of stay were risk factors of POD, with the largest effect for NLR ≥ 7.6. NLR ≥ 7.6 (β 0.59, [95% CI 0.209 to 0.886], p = 0.038), older age (β 0.054, [95% CI 0.009 to 0.099], p = 0.019), previous stroke (β 0.908, [95% CI 0.085 to 1.731], p = 0.031), and previous heart failure (β 1.679, [95% CI 0.448 to 2.910], p = 0.008) suggested long POD duration.ConclusionsThis study demonstrates an association between NLR and postoperative delirium in geriatric hip fracture patients, and contribute new evidence to support NLR as a potential marker for prediction of POD and POD duration.

Clinical effectiveness of a fracture liaison service for geriatric hip fracture patients in Hong Kong

Introduction: Fragility hip fracture has become a huge public health burden with ageing population. Yet workup and treatment of osteoporosis following a fragility fracture remain under-utilised in clinical practice. The purpose of this study was to evaluate the clinical effectiveness of Fracture Liaison Service (FLS) in preventing future fractures and mortality rate following hip fracture in Hong Kong. Investigation and treatment rate of osteoporosis were also assessed. Methods: A retrospective single-centre cohort study was conducted to study patients aged over 65 years admitted to our hospital for fragility hip fracture before and after FLS implementation. Patients who were recruited in the FLS programme following hospital admission from October 2020 to September 2021 were regarded as the intervention group, whereas those admitted from April 2019 to March 2020 were regarded as historical control. The follow up time was 15 months for both groups. Results: A total of 139 patients were included in the study, with 68 in the intervention group and 71 in the control group. The refracture rate dropped from 5.6% to 0% after FLS implementation, while the 15-month mortality rate increased slightly from 0% to 2.9%, both of which did not show statistical significance, with a p-value of .120 and .238 respectively. Post-injury bone density investigation rate increased from 8.5% to 60.3%, and antiosteoporotic treatment initiation rate increased from 19.7% to 97.1%. Both of them showed statistical significance ( p < .001). Treatment discontinuation rate decreased from 14.3% to 7.8%, with a p-value of .603. Conclusions: FLS implementation in Hong Kong was an effective tool to increase investigation and treatment rate of osteoporosis in geriatric hip fracture patients. Its impact on refracture and mortality rate remained insignificant in this cohort of patients. Further study with a longer follow up time and more delicate selection of participants may demonstrate a better outcome.

Chronic Preinjury Anemia Is Associated With Increased Risk of 1-Year Mortality in Geriatric Hip Fracture Patients.

To assess whether a diagnosis of preexisting anemia impacts outcomes of geriatric hip fractures. This is a retrospective comparative study conducted at a single, urban hospital system consisting of an orthopaedic specialty hospital, two level 1 trauma centers, and one university-based tertiary care hospital. Data of patients aged 55 years or older with a femoral neck, intertrochanteric, or subtrochanteric hip fracture (AO/OA 31A, 31B, and 32A-C) at a single hospital center treated from October 2014 to October 2023 were retrieved from an institutional review board-approved database. Patients were included if they had a hemoglobin measurement recorded between 6 and 12 months before hospitalization for their hip fracture. Patients were cohorted based on whether their hemoglobin values recorded anemic or not. Comparative analysis was conducted to analyze 1-year mortality, 30-day mortality, 30-day readmission, 90-day readmission, and inpatient major complications. Four hundred ninety-eight patients had hemoglobin values recorded at 6 to 12 months before their surgery in the electronic medical record. Two hundred seventy-three patients (54.8%) were considered anemic at that time, whereas 225 patients (45.2%) were not. Cohorts were markedly different regarding sex, Charlson Comorbidity Index, preinjury ambulatory status, and Score for Trauma Triage in Geriatric and Middle-Aged Patients (STTGMA) score (P < 0.05 for all). Multivariable analysis revealed that chronic preinjury anemia patients had a higher likelihood of 1-year mortality and a higher risk of major inpatient complication and 30- and 90-day readmission (P < 0.05 for all). Chronic preinjury anemia within 6 to 12 months before a hip fracture is associated with an increased risk of 1-year mortality, inpatient major complications, and 30- and 90-day readmission after hip fracture fixation. Level III.

Efficacy of Postoperative Oral Nutritional Supplements in Geriatric Hip Fracture Patients Undergoing Total Hip Arthroplasty.

Background/Objectives: Geriatric hip fracture patients have an increased risk of malnutrition. Proper nutritional supply in the perioperative period is very important for their recovery. Oral nutritional supplements (ONSs) are recommended in geriatric hip fracture patients to improve dietary intake and prevent complications. This study aimed to evaluate the efficacy of postoperative ONSs after total hip arthroplasty in geriatric hip fracture patients. Methods: A retrospective study of elderly patients who underwent total hip arthroplasty for hip fracture was conducted. Data from patients who received ONSs postoperatively until hospital discharge (ONS group, n = 69) were compared with patients who did not receive ONSs (control group, n = 168). Laboratory test results, including serum protein and albumin levels, length of hospital stay, and the incidence of postoperative medical complications of the two groups, were analyzed. Results: Preoperative serum protein and albumin levels were significantly higher in the control group (p = 0.002 and p = 0.010, respectively). However, the degree of decline for both protein and albumin levels was significantly less in the ONS group (p < 0.001 for both). Serum albumin levels were significantly higher in the ONS group at postoperative two-week follow-up (p = 0.006). The length of hospital stay was shorter in the ONS group (p < 0.001). The incidence of postoperative delirium was significantly higher in the control group (p = 0.007). Conclusions: In geriatric hip fracture patients, postoperative ONSs can improve postoperative nutritional status, shorten the length of hospital stay, and reduce the incidence of postoperative delirium.

Prognostic Nutritional Index (PNI) as an Independent Predictor of 3-Year Postoperative Mortality in Elderly Patients with Hip Fracture: A Post hoc Analysis of a Prospective Cohort Study.

The prognostic nutritional index (PNI) has been reported as a significant predictor in various diseases. However, the prognostic value of the PNI in geriatric hip fracture patients has not been thoroughly evaluated. This study aimed to investigate the association between admission PNI and 3-year mortality in those patients. In this post hoc analysis, we included patients aged ≥65 years who underwent surgery for hip fracture between 2018 and 2019. The admission PNI was calculated as serum albumin (g/L) +5 × total lymphocyte count (×109/L). Patients were categorized into four groups based on PNI quartiles (≤ 43.55, 43.55-46.55, 46.55-49.20, and >49.20, respectively). The median follow-up duration was 3.1 years. Cox proportional hazards models were used to calculate the hazard ratio (HR). Receiver operating characteristic curve (ROC) was conducted for using PNI to predict mortality. Of the 942 eligible patients, 190 (20.2%) patients died during the follow-up. Compared to patients in the first quartile (Q1), those in the second (Q2), third (Q3), and fourth (Q4) quartiles had significantly lower mortality risks (HRs 0.50, 95% CI 0.35-0.74; 0.41, 95% CI 0.26-0.64; and 0.26, 95% CI 0.15-0.45, respectively). The optimal cutoff of PNI for predicting mortality was set as 45.275 (sensitivity, 0.674; specificity, 0.692; area under the curve (AUC), 0.727). Patients with higher PNI (>45.275) had a significant lower mortality risk (HR 0.39, 95% CI 0.28-0.55) compared to those with lower PNI (≤ 45.275). PNI is a reliable and independent predictor of 3-year mortality after hip fracture surgery in the elderly.

Under pressure: symptomatic pulmonary hypertension is a predictor of poor outcome following hip fracture.

Pulmonary hypertension (PHTN) is associated with increased morbidity and mortality in noncardiac surgery and elective surgery. This population of patients has a low physiological reserve and is prone to cardiac arrest as a result. This study aims to identify the impact that PHTN has on outcomes among geriatric hip fracture patients. A 3:1 propensity-score-matched retrospective case (PHTN)-control (no PHTN [N]) study of hip fracture patients from 2014 to 2022 was performed. Patients were matched utilizing propensity score matching of a validated geriatric trauma risk assessment tool (STTGMA). All patients were reviewed for hospital quality measures and outcomes. Comparative univariable and multivariable analyses were conducted between the two matched cohorts. A sub-analysis compared patients across PHTN severity levels (mild, moderate, severe) based on pulmonary artery systolic pressures (PASP) as measured by transthoracic echocardiogram. PHTN patients (n = 67) experienced a higher rate of inpatient, 30-day, and 1-year mortality, major complications, and 90-day readmissions as compared to the N cohort (n = 201). PHTN patients with a PASP > 60 experienced a significantly higher rate of major complications, need for ICU, longer admission length, and worse 1-year functional outcomes. Pulmonary hypertension was found to be independently associated with a 3.5 × higher rate of 30-day mortality (p = 0.016), 2.7 × higher rate of 1-year mortality (p = 0.008), 2.5 × higher rate of a major inpatient complication (p = 0.028), and 1.2 × higher rate of 90-day readmission (p = 0.044). Patients who had a prior diagnosis of pulmonary hypertension before sustaining their hip fracture experienced significantly worse inpatient and post-discharge outcomes. Those with a PASP > 60mmHg had worse outcomes within the PHTN cohort. Providers must recognize these at-risk patients at the time of arrival to adjust care planning accordingly. III.

Comparative analysis of geriatric hip fracture management outcomes in teaching and nonteaching hospitals in Jordan

Hip fractures are common orthopedic injuries that have significant impacts on patients and healthcare systems. Previous studies have shown varying outcomes for hip fracture management in different settings, with diverse postoperative outcomes and complications. While teaching hospital settings have been investigated, no studies have specifically examined hip fracture outcomes in teaching hospitals in Jordan or the broader Middle East region. Therefore, the aim of this study was to investigate this important outcome. A cohort comprising 1268 patients who underwent hip fracture fixation from 2017 to 2020 was analyzed for nine distinct outcomes. These outcomes encompassed time to surgery, ICU admissions, perioperative hemoglobin levels, length of hospital stay, readmission rates, revision procedures, and mortality rates at three time points: in-hospital, at 6-months, and at 1-year post-surgery. The analysis of 1268 patients (616 in teaching hospitals, 652 in non-teaching hospitals) showed shorter mean time to surgery in teaching hospitals (2.2 days vs. 3.6 days, p < 0.01), higher ICU admissions (17% vs. 2.6%, p < 0.01), and more postoperative blood transfusions (40.3% vs. 12.1%, p < 0.01). In-hospital mortality rates were similar between groups (2.4% vs. 2.1%, p = 0.72), as were rates at 6-months (3.1% vs. 3.5%, p = 0.65) and 1-year post-surgery (3.7% vs. 3.7%, p = 0.96). Geriatric hip fracture patients in teaching hospitals have shorter surgery times, more ICU admissions, and higher postoperative blood transfusion rates. However, there are no significant differences in readmission rates, hospital stays, or mortality rates at various intervals.

Association between preoperative persistent hyperglycemia and postoperative delirium in geriatric hip fracture patients

BackgroundThe management of preoperative blood glucose levels in reducing the incidence of postoperative delirium (POD) remains controversial. This study aims to investigate the impact of preoperative persistent hyperglycemia on POD in geriatric patients with hip fractures.MethodsThis retrospective cohort study analyzed medical records of patients who underwent hip fracture surgery at a tertiary medical institution between January 2013 and November 2023. Patients were categorized based on preoperative hyperglycemia (hyperglycemia defined as ≥ 6.1mmol/L), clinical classification of hyperglycemia, and percentile thresholds. Multivariate logistic regression and propensity score matching analysis (PSM) were employed to assess the association between different levels of preoperative glucose and POD. Subgroup analysis was conducted to explore potential interactions.ResultsA total of 1440 patients were included in this study, with an incidence rate of POD at 19.1% (275/1440). Utilizing multiple logistic analysis, we found that patients with hyperglycemia had a 1.65-fold increased risk of experiencing POD compared to those with normal preoperative glucose levels (95% CI: 1.17–2.32). Moreover, a significant upward trend was discerned in both the strength of association and the predicted probability of POD with higher preoperative glucose levels. PSM did not alter this trend, even after meticulous adjustments for potential confounding factors. Additionally, when treating preoperative glucose levels as a continuous variable, we observed a 6% increase in the risk of POD (95% CI: 1-12%) with each 1mmol/L elevation in preoperative glucose levels.ConclusionsThere exists a clear linear dose-response relationship between preoperative blood glucose levels and the risk of POD. Higher preoperative hyperglycemia was associated with a greater risk of POD.Clinical trial numberNCT06473324.

Analgesic Efficacy of Ultrasound-guided Fascia Iliaca Compartment Block (FICB) and Outcomes in Preoperative Fast-track Geriatric Patients with Hip Fracture: A Single-center Retrospective Study

Objective: This study aimed to evaluate the analgesic efficacy of preoperative fascia iliaca compartment block (FICB) in terms of preoperative pain score reduction in geriatric hip fracture patients. Secondary objectives were to compare opioid consumption, procedure-related complications, and patient outcomes. Materials and Methods: This single-center retrospective study included patients aged 65 or older with hip fractures who experienced moderate to severe pain in a tertiary care university hospital from January 2019 to July 2021. The variables collected for analysis were patient baseline characteristics and the pain score at rest, including during movement from the beginning of service and subsequently each morning after admission until the day of surgery. Results: A total of 439 patients were included in this study, 109 patients (24.8%) receiving preoperative FICB (FICB group). When comparing the FICB and non-FICB groups, a significant reduction in pain scores was observed on postadmission day 1, both at rest (0 [IQR=0-4] vs. 0 [IQR=0-2], p&lt;0.001) and during movement (0 [IQR=0-4] vs. 0 [IQR=0-2], p=0.018). This difference in pain reduction persisted on day 2 during movement (3 [IQR=0-5.75] VS 0 [IQR=0-3], p=0.001). No significant differences in preoperative opioid consumption or postoperative morbidities were observed between these two groups, and no complications related to the procedure were observed. Conclusion: For patients experiencing moderate to severe preoperative pain at the beginning of treatment, preoperative FICB can reduce pain scores for up to 2 days.

WITHDRAWN: The effect of delayed admission on the incidence of preoperative deep vein thrombosis and changes in coagulation status at admission in geriatric hip fracture patients

WITHDRAWN: The effect of delayed admission on the incidence of preoperative deep vein thrombosis and changes in coagulation status at admission in geriatric hip fracture patients

Patient and proxy perspectives in decision-making for geriatric hip fracture management in the Netherlands: a qualitative study

ObjectiveThe objective of this study was to explore the perspectives with the decision-making process between surgery and palliative, non-operative management of geriatric hip fracture patients and their proxies.DesignA qualitative interview...

Retrospective Analysis of Risk Factors in Geriatric Hip Fracture Patients Predictive of Surgical Intensive Care Unit Admission.

Although numerous risk factors and prediction models affecting morbidity and mortality in geriatric hip fracture patients have been previously identified, there are scant published data on predictors for perioperative Surgical Intensive Care Unit (SICU) admission in this patient population. Determining if a patient will need an SICU admission would not only allow for the appropriate allocation of resources and personnel but also permit targeted clinical management of these patients with the goal of improving morbidity and mortality outcomes. The purpose of this study was to identify specific risk factors predictive of SICU admission in a population of geriatric hip fracture patients. Unlike previous studies which have investigated predominantly demographic, comorbidity, and laboratory data, the present study also considered a frailty index and length of time from injury to presentation in the Emergency Department (ED). A total of 501 geriatric hip fracture patients admitted to a Level 1 trauma center were included in this retrospective, single-center, quantitative study from January 1, 2019, to December 31, 2022. Using a logistical regression analysis, more than 25 different variables were included in the regression model to identify values predictive of SICU admission. Predictive models of planned versus unplanned SICU admissions were also estimated. The discriminative ability of variables in the final models to predict SICU admission was assessed with receiver operating characteristic curves' area under the curve estimates. Frailty,serum lactate > 2, andpresentation to the ED > 12 hours after injurywere significant predictors of SICU admission overall (P = 0.03, 0.038, and 0.05 respectively). Additionally, the predictive model for planned SICU admission had no common significant predictors with unplanned SICU admission. Planned SICU admission significant predictors included an Injury Severity Score (ISS) of 15 and greater, a higher total serum protein, serum sodium <135, systolic blood pressure (BP) under 100, increased heart rate on admission to ED, thrombocytopenia (<120), and higher Anesthesia Society Association physical status classification (ASA) score (P = 0.007, 0.04, 0.05, 0.002, 0.041, 0.05, and 0.005 respectively). Each SICU prediction model (overall, planned, and unplanned) demonstrated sufficient discriminative ability with the area under the curve (AUC) values of 0.869, 0.601, and 0.866 respectively.Finally, mean hospital Length of Stay (LOS) and mortality were increased in SICU admissions when compared to non-SICU admissions. Of the three risk factors predictive of SICU admission identified in this study, two have not been extensively studied previously in this patient population. Frailty has been associated with increased mortality and postoperative complications in hip fracture patients, but this is the first study to date to use a novel frailty index specifically designed and validated for use in hip fracture patients. The other risk factor, time from injury to presentation to the ED serves as an indicator for time a hip fracture patient spent without receiving medical attention. This risk factor has not been investigated heavily in the past as a predictor of SICU admissions in this patient population.

Random forest predictive modeling of prolonged hospital length of stay in elderly hip fracture patients.

In elderly individuals suffering from hip fractures, a prolonged hospital length of stay (PLOS) not only heightens the probability of patient complications but also amplifies mortality risks. Yet, most elderly hip fracture patients present compromised baseline health conditions. Additionally, PLOS leads to increased expenses for patient treatment and care, while also diminishing hospital turnover rates. This, in turn, jeopardizes the prompt allocation of beds for urgent cases. A retrospective study was carried out from October 2021 to November 2023 on 360 elderly hip fracture patients who underwent surgical treatment at West China Hospital. The 75th percentile of the total patient cohort's hospital stay duration, which was 12 days, was used to define prolonged hospital length of stay (PLOS). The cohort was divided into training and testing datasets with a 70:30 split. A predictive model was developed using the random forest algorithm, and its performance was validated and compared with the Lasso regression model. Out of 360 patients, 103 (28.61%) experienced PLOS. A Random Forest classification model was developed using the training dataset, identifying 10 essential variables. The Random Forest model achieved perfect performance in the training set, with an area under the curve (AUC), balanced accuracy, Kappa value, and F1 score of 1.000. In the testing set, the model's performance was assessed with an AUC of 0.846, balanced accuracy of 0.7294, Kappa value of 0.4325, and F1 score of 0.6061. This study aims to develop a prognostic model for predicting delayed discharge in elderly patients with hip fractures, thereby improving the accuracy of predicting PLOS in this population. By utilizing machine learning models, clinicians can optimize the allocation of medical resources and devise effective rehabilitation strategies for geriatric hip fracture patients. Additionally, this method can potentially improve hospital bed turnover rates, providing latent benefits for the healthcare system.

Establishment and validation of an artificial intelligence web application for predicting postoperative in-hospital mortality in patients with hip fracture: a national cohort study of 52707 cases.

In-hospital mortality following hip fractures is a significant concern, and accurate prediction of this outcome is crucial for appropriate clinical management. Nonetheless, there is a lack of effective prediction tools in clinical practice. By utilizing artificial intelligence (AI) and machine learning techniques, this study aims to develop a predictive model that can assist clinicians in identifying geriatric hip fracture patients at a higher risk of in-hospital mortality. A total of 52707 geriatric hip fracture patients treated with surgery from 90 hospitals were included in this study. The primary outcome was postoperative in-hospital mortality. The patients were randomly divided into two groups, with a ratio of 7:3. The majority of patients, assigned to the training cohort, were used to develop the AI models. The remaining patients, assigned to the validation cohort, were used to validate the models. Various machine learning algorithms, including logistic regression (LR), decision tree (DT), naïve bayesian (NB), neural network (NN), eXGBoosting machine (eXGBM), and random forest (RF), were employed for model development. A comprehensive scoring system, incorporating 10 evaluation metrics, was developed to assess the prediction performance, with higher scores indicating superior predictive capability. Based on the best machine learning-based model, an AI application was developed on the Internet. In addition, a comparative testing of prediction performance between doctors and the AI application. The eXGBM model exhibited the best prediction performance, with an area under the curve (AUC) of 0.908 (95% CI: 0.881-0.932), as well as the highest accuracy (0.820), precision (0.817), specificity (0.814), and F1 score (0.822), and the lowest Brier score (0.120) and log loss (0.374). Additionally, the model showed favorable calibration, with a slope of 0.999 and an intercept of 0.028. According to the scoring system incorporating 10 evaluation metrics, the eXGBM model achieved the highest score (56), followed by the RF model (48) and NN model (41). The LR, DT, and NB models had total scores of 27, 30, and 13, respectively. The AI application has been deployed online at https://in-hospitaldeathinhipfracture-l9vhqo3l55fy8dkdvuskvu.streamlit.app/ , based on the eXGBM model. The comparative testing revealed that the AI application's predictive capabilities significantly outperformed those of the doctors in terms of AUC values (0.908 vs. 0.682, P <0.001). The eXGBM model demonstrates promising predictive performance in assessing the risk of postoperative in-hospital mortality among geriatric hip fracture patients. The developed AI model serves as a valuable tool to enhance clinical decision-making.

Hypnotic drug use and rehabilitation outcomes in post-acute geriatric hip fracture patients: A retrospective study

IntroductionThe use of hypnotic drugs is common in the elderly and is associated with negative health outcomes. Our aim was to evaluate the prevalence of hypnotic drug usage amongst hip fracture patients undergoing a rehabilitation program and investigate any potential associations between hypnotic drug use and rehabilitation outcomes in a post-acute care setting. MethodsA retrospective analysis of 440 geriatric hip fracture patients was conducted from 1/1/2019 to 12/2021 in a geriatric rehabilitation center. The main outcome measures were the Functional Independence Measure (FIM), the motor FIM effectiveness and length of stay (LOS). ResultsTwo hundred and twenty-eight (51.7 %) patients out of the entire cohort (440)), were prescribed hypnotic drugs. These patients exhibited a significantly lower rate of diabetes (p = 0.025), a higher rate of depression (p = 0.003), and lower albumin levels (p = 0.023) upon admission to rehabilitation in comparison to untreated patients. No significant differences were observed between the two patient groups in functional rehabilitation outcomes or LOS. Moreover, no correlation was established between the hypnotic drug burden during rehabilitation and the outcome measures. Furthermore, no significant differences were found between patients treated with hypnotic drugs on admission and those who were prescribed these drugs during rehabilitation. The type of hypnotic drug did not affect these results. ConclusionThe use of hypnotic drugs by elderly individuals undergoing a rehabilitation program after a hip fracture is unlikely to have an adverse impact on their short-term rehabilitation outcomes. Consequently, there may not be an immediate necessity to discontinue these drugs upon admission. Nevertheless, the use of hypnotic drugs should be approached with caution and minimized whenever possible due to an increased fall risk and other adverse effects.

The hip fracture assessment tool: A scoring system to assess high risk geriatric hip fracture patients for post-operative critical care monitoring

IntroductionIntensive care unit risk stratification models have been utilized in elective joint arthroplasty; however, hip fracture patients are fundamentally different in their clinical course. Having a critical care risk calculator utilizing pre-operative risk factors can improve resourcing for hip fracture patients in the peri‑operative period. MethodsA cohort of geriatric hip fracture patients at a single institution were reviewed over a three-year period. Non-operative patients, peri‑implant fractures, additional procedures performed under the same anesthesia period, and patients admitted to the intensive care unit (ICU) prior to surgery were excluded. Pre-operative laboratory values, Revised Cardiac Risk Index (RCRI), and American Society of Anesthesiologists (ASA) scores were calculated. Pre-operative ambulatory status was determined. The primary outcome measure was ICU admission in the post-operative period. Outcomes were assessed with Fisher's exact test, Kruskal-Wallis test, logistic regression, and ROC curve. Results315 patient charts were analyzed with 262 patients meeting inclusion criteria. Age ≥ 80 years, ASA ≥ 4, pre-operative hemoglobin < 10 g/dL, and a history of CVA/TIA were found to be significant factors and utilized within a “training” data set to create a 4-point scoring system after reverse stepwise elimination. The 4-point scoring system was then assessed within a separate “validation” data set to yield an ROC area under the curve (AUC) of 0.747. Score ≥ 3 was associated with 96.8 % specificity and 14.2 % sensitivity for predicting post-op ICU admission. Score ≥ 3 was associated with a 50 % positive predictive value and 83 % negative predictive value. ConclusionA hip fracture risk stratification scoring system utilizing pre-operative patient specific values to stratify geriatric hip patients to the ICU post-operatively can improve the pre-operative decision-making of surgical and critical care teams. This has important implications for triaging vital hospital resources. Level of evidenceIII (retrospective study)

A retrospective chart analysis with 5-year follow-up of early care for geriatric hip fracture patients: why we should continue talking about hip fractures.

Timing of surgery remains a topic of debate for hip fracture treatment in the geriatric patient population. The quality indicator "early surgery" was implemented in 2014 at the Department of Trauma Surgery of the University Hospitals Leuven to enhance timely operative treatment. In this follow-up study, we aim to evaluate the performance of this quality indicator, the clinical outcomes, and room for improvement. The charts of 1190 patients surgically treated for an acute hip fracture were reviewed between June 2017 and May 2022 at the University Hospitals Leuven. Primary endpoints were adherence to early surgery, defined as surgery within the next calendar day, and the evaluation of the reasons for deviating from this protocol. Secondary endpoints were length of stay (LOS); intensive care unit (ICU) admission and length of ICU stay; mortality after 30days, 60days, 90days, and 6months; and 90-day readmission rate. Pearson's Chi-square test and Mann-Whitney U test were used for data analysis. One thousand eighty-four (91.1%) patients received early surgery versus 106 (8.9%) patients who received delayed surgery. The main reasons for surgical delay were the use of anticoagulants (33%), a general health condition not allowing safe surgery and/or existing comorbidities requiring workup prior to surgery (26.4%), and logistical reasons (17.9%). Patient delay and transfer from other hospitals were responsible for respectively 8.5% and 6.6% of delayed surgery. Early surgery resulted in a significantly shorter LOS and ICU stay (12 [8-25] vs. 18 [10-36] and 3 [2-6] vs. 7 [3-13] days, early vs. delayed surgery, respectively). No significant reduction was observed in ICU admission, mortality, and readmission rate. We have been able to maintain the early surgery hip fracture protocol in approximately 90% of the patients. Comorbidities and anticoagulant use were responsible for delayed surgery in the majority of the patients. Correct implementation of the existing protocol on anticoagulant use could lead to a one-third decrease in the number of delayed surgeries. Subsequently, since the LOS and ICU stay in the delayed surgery group were significantly longer, a further increase of early surgery will lower the current economic burden.

IJCM_101A: Prevalence of postoperative delirium in geriatric patients with hip fracture.

Background: Geriatric hip fractures are a major cause of concern globally and often a frequent reason for morbidity and mortality. Postoperative delirium (POD) is frequent but often under-diagnosed complication, especially after a major hip surgery. Some of the factors contributing to delirium are sepsis, dyselectrolytemia, elevated blood sugars, blood pressure fluctuation, constipation, and malnutrition. It very important to prevent delirium and to treat the underlying cause contributing to it. Objective: Prevalence of postoperative delirium in Geriatric patients with hip fracture and to determine various factors associated with it. Methodology: Prospective study Samples are collected from geriatric hip fracture patients admitted in a tertiary health care centre. Data regarding preoperative blood investigations, hypertension, and diabetes status, MNA (mini nutritional assessments) status, serum albumin, and serum electrolytes values were recorded. The Confusion Assessment Method tool (CAM) was used to diagnose delirium in the postoperative period. Results: 140 patients fulfilling the inclusion and exclusion criteria were admitted to the study. Among the one hundred and forty patients, forty-nine patients developed delirium. The incidence of delirium in the postoperative period was 35%. The percentage of patients developing delirium was directly proportional to their advancing age In these patients major risk factor associated with delirium was pain, constipation, urosepsis (fever), dyselectrolytemia, uncontrolled glycemic status and prolonged hospital stay (delayed rehabilitation) Conclusion: Delirium is a common feature in the post-operative period in the elderly patients associated with acute alteration in attention and cognitive impairment, which is responsible for the significant increase in both morbidity and mortality. Multiple factors predispose a patient to different forms of delirium. The reversible causes must be identified and treated promptly. A wider knowledge of pathophysiology and clinical awareness can help to counter the possible deleterious effects of delirium during the post-operative period.

The Impact of Implementation of Palliative, Non-Operative Management on Mortality of Operatively Treated Geriatric Hip Fracture Patients: A Retrospective Cohort Study.

(1) Background: Hip fracture patients with very limited life expectancy can opt for non-operative management (NOM) within a palliative care context. The implementation of NOM in the palliative context may affect the mortality of the operatively treated population. This retrospective cohort study aimed to determine whether the operatively treated geriatric hip fracture population would have a lower in-hospital mortality rate and fewer postoperative complications after the introduction of NOM within a palliative care context for patients with very limited life expectancy. (2) Methods: Data from 1 February 2019 to 1 February 2022 of patients aged 70 years or older were analyzed to give a comparison between patients before and after implementation of NOM within a palliative care context. (3) Results: Comparison between 550 patients before and 485 patients after implementation showed no significant difference in in-hospital or 1-year mortality rates (2.9% vs. 1.4%, p = 0.139; 22.4% vs. 20.2%, p = 0.404, respectively). Notably, post-implementation, fewer patients had prior dementia diagnoses (15% vs. 21%, p = 0.010), and intensive care unit admissions decreased (3.5% vs. 1.2%, p = 0.025). (4) Conclusions: The implementation of NOM within a palliative care context did not significantly reduce mortality or complications. However, NOM within palliative care is deemed a more patient-centered approach for geriatric hip fracture patients with very limited life expectancy.

Randomized controlled trial on analgesic effect of pre-operative fascia iliaca compartment block in geriatric patients with hip fracture

Objective While most geriatric patients with hip fracture benefit from definitive operative treatment, pre-operative pain management is often overlooked. Conventional oral analgesics may provide suboptimal pain control, resulting in poor morbidity outcomes. Fascia iliaca compartment block (FICB) provides a more consistent analgesic effect. This study aims to provide high level local evidence on the effect of FICB in pre-operative pain control for these patients in Hong Kong. Materials and Methods This study was a double-blinded randomized controlled trial. Mentally competent geriatric patients with acute fracture hip, admitted to United Christian Hospital, were recruited to receive pre-operative FICB. The procedure was carried out by landmark approach with addition of ultrasonography-guidance. They were randomized into intervention group (receiving 0.25% levobupivacaine), and control group (receiving normal saline as placebo). Numeric Rating Scale of pain score (at rest, and on gentle movement) at different time intervals, timing of injection, systemic analgesic use, complications, and demographics were compared. Results Total 80 patients were recruited from July 2019 to September 2021 and randomized into intervention and control groups. Two patients in intervention group and 1 in control group were withdrawn due to development of delirium. Demographics of both groups were comparable. Pain score at rest was significantly lower at 12 h after injection in intervention group (41.4% reduction, p = 0.03). Pain score upon gentle movement was significantly lower in intervention group at 1 h (p = 0.01), 12 h (28.9% reduction, p = 0.003) and 24 h after injection (p = 0.01). There was no complication from the procedure documented. Total systemic analgesic use was similar in both groups. Conclusion FICB is an effective choice of pre-operative analgesia for geriatric hip fracture patients with good safety profile, especially in controlling pain induced by movement. It shall be considered as a routine practice for suitable patients.