Elderly Hip Fracture Patients Research Articles

Glucose-albumin ratio (GAR) as a novel biomarker of postoperative urinary tract infection in elderly hip fracture patients

PurposePostoperative urinary tract infections (UTIs) worsen the prognosis of elderly patients with hip fractures. This study aimed to assess the predictive ability of blood-based biomarkers, specifically the glucose-albumin ratio (GAR), in predicting postoperative UTIs.MethodsA retrospective observational study of 1,231 patients from a Level I trauma center was conducted. We evaluated the prognostic and predictive value of 15 biomarkers, including the glucose-albumin ratio, in elderly patients with hip fractures. The primary outcome measure was the incidence of postoperative UTIs.ResultsThe glucose to albumin ratio transformed into GAR was superior to any other biomarker in predicting postoperative UTIs in elderly hip fracture patients (AUC = 0.756, p < 0.001). Elevated GAR (using the best cut-off value of 0.18) was independently associated with postoperative UTIs (OR 3.20, 95% CI 2.23–4.58). Further analysis dividing GAR levels into four groups according to quartiles showed that compared to patients with GAR levels of Q1 (< 0.14), GAR levels of Q2 (0.14–0.17; OR 2.11, 95% CI 1.07–4.15), Q3 (0.17–0.21; OR 3.36, 95% CI 1.74–6.52) and Q4 (> 0.21; OR 7.55, 95% CI 3.84–14.83) patients had significantly higher odds of UTIs.ConclusionGAR holds potential as a novel biomarker for predicting postoperative UTIs in elderly patients with hip fractures.

Surgery on admission and following day reduces hip fracture complications: a Japanese DPC study.

The efficacy of early surgery in preventing complications among Japanese elderly patients with hip fractures requires further investigation. This study aims to use a comprehensive Japanese hip fracture case database to determine whether surgery within the day of admission and the following day reduces the incidence of complications and mortality during hospitalization in elderly hip fracture patients. We retrospectively analyzed the Japanese National Administrative DPC (Diagnosis Procedure Combination) database from April 2016 to March 2022. Approximately 1100 DPC-affiliated hospitals consistently provided medical records with consent for research. The study investigated the association between postoperative pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization after propensity score matching, focusing on surgeries conducted on the day of admission and the following day. After one-to-one propensity score matching for age, gender, and comorbidity, we identified 146,441 pairs of patients who underwent surgery either within the day of admission and the following day or after the third day of admission. Surgery on the third day or later was independently associated with increased risks of pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization with risk ratios of 1.367 (95% CI 1.307-1.426), 1.328 (95% CI 1.169-1.508), 1.338 (95% CI 1.289-1.388), and 1.167 (95% CI 1.103-1.234), respectively. A comprehensive study of elderly Japanese patients with hip fractures in the DPC database showed that surgery on admission and the following day is crucial for preventing complications like pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization.

Preoperative Thyroid-Stimulating Hormone Levels and Three-Year Mortality in Elderly Hip Fracture Patients: Insights from a Prospective Cohort Study

Preoperative Thyroid-Stimulating Hormone Levels and Three-Year Mortality in Elderly Hip Fracture Patients: Insights from a Prospective Cohort Study

Effects of Intrathecal Versus General Anesthesia on Postoperative Cognitive Function in Elderly Hip Fracture Patients: a System Review and Meta Analysis Protocol

Randomized controlled studies have shown that the incidence of postoperative cognitive function in elderly patients undergoing hip fracture surgery varies significantly by anesthesia type. The aim of this study was to assess the effects of intrathecal anesthesia and general anesthesia on postoperative cognitive function in elderly hip fracture by system review and meta-analysis. This study followed the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-analyses. First, the Cochrane Library, Web of Science, PubMed, EMBASE, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and Clinical Trials Database were searched. Second, the literature was screened and identified for inclusion step by step according to the established inclusion and exclusion criteria using Endnote. Further, Excel 2010 was used to record the basic characteristics and relevant data of the included literature, and the Cochrane Risk of Bias Assessment Tool was used to rate the quality of each included study. Subsequently, meta-analysis was performed using RevMan 5.3 software to assess the effects of intrathecal anesthesia and general anesthesia on postoperative cognitive function of hip fracture in the elderly, and funnel plots were drawn to assess publication bias. The results of this systematic evaluation and meta-analysis will be published in a peer-reviewed journal.

Effects of Intrathecal Versus General Anesthesia on Postoperative Cognitive Function in Elderly Hip Fracture Patients: a System Review and Meta Analysis Protocol

Randomized controlled studies have shown that the incidence of postoperative cognitive function in elderly patients undergoing hip fracture surgery varies significantly by anesthesia type. The aim of this study was to assess the effects of intrathecal anesthesia and general anesthesia on postoperative cognitive function in elderly hip fracture by system review and meta-analysis. This study followed the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-analyses. First, the Cochrane Library, Web of Science, PubMed, EMBASE, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and Clinical Trials Database were searched. Second, the literature was screened and identified for inclusion step by step according to the established inclusion and exclusion criteria using Endnote. Further, Excel 2010 was used to record the basic characteristics and relevant data of the included literature, and the Cochrane Risk of Bias Assessment Tool was used to rate the quality of each included study. Subsequently, meta-analysis was performed using RevMan 5.3 software to assess the effects of intrathecal anesthesia and general anesthesia on postoperative cognitive function of hip fracture in the elderly, and funnel plots were drawn to assess publication bias. The results of this systematic evaluation and meta-analysis will be published in a peer-reviewed journal.

Trends in Hospital Stay, Complication Rate, and Mortality in Hip Fracture Patients: A Two-Decade Comparison at a National Tertiary Referral Center.

Background: Since the turn of the century, the age-adjusted incidence of proximal femoral fractures has caused a plateau or fall. However, it was anticipated that the number of patients with proximal femoral fractures would rise as life expectancy rose and the population over 80 years old expanded. The aim of this study was to compare the length of hospital stay, complication rate, and mortality in patients with proximal femoral fractures between two different time periods: 20 years ago and the present. Methods: We conducted a retrospective review of medical records of patients aged 65 years and above who underwent surgery for proximal femoral fractures between January 2000 and December 2001 and between January 2020 and December 2021. We collected information on age, gender, fracture type, length of hospital stay, and complication rate. Dates of death were obtained from the Ministry of the Interior and Safety. Results: We included 136 patients who were operated on between 2000 and 2001 and 134 patients between 2020 and 2021. The average age increased significantly from 71.6 years to 79.0 years (p < 0.001). The length of hospital stay decreased dramatically from 15.1 days to 6.0 days (p < 0.001). There was no statistically significant difference in delirium, urinary tract infection, or pneumonia. No difference was found in 30-day or 1-year mortality between the two groups. Conclusions: The complication rate and mortality between the two time periods appeared comparable, although the length of hospital stay decreased substantially. Therefore, we recommend considering expedited discharge from the acute care hospital for elderly hip fracture patients while implementing an individualized approach for better outcomes.

Relationship between preoperative hemoglobin levels and length of stay in elderly patients with hip fractures: A retrospective cohort study.

Globally, hip fractures in elderly individuals are a prevalent and serious issue. Patients typically have a longer length of stay (LOS), which increases the risk of complications and increases hospitalization costs. Hemoglobin (Hb) is a routine blood test that is associated with disease prognosis. This study aimed to investigate the relationship between preoperative Hb and LOS in elderly hip fracture patients and to determine a reliable transfusion threshold. The clinical data of hip fracture patients (aged ≥ 60 years) admitted to the Department of Orthopaedics, Shenzhen Second People's Hospital, between January 2012 and December 2021 were retrospectively analyzed. Multiple linear regression analysis was used to assess the linear relationship between preoperative Hb and LOS. Smooth curve fitting was performed to investigate potential nonlinear relationships. In the case of discovering nonlinear relationships, a weighted two-piecewise linear regression model was built, and the inflection points were determined using a recursive algorithm. Subgroup analyses were conducted based on age and gender. A total of 1444 patients with an average age of (77.54 ± 8.73) years were enrolled. After adjusting for covariates, a nonlinear relationship was found between preoperative Hb and LOS. The two-piecewise linear regression model revealed an inflection point of 10 g/dL. On the left of the inflection point (Hb < 10 g/dL), the LOS was reduced by 0.735 days for every 1 g/dL increase in Hb (β = -0.735, 95% confidence interval: -1.346 to -0.124, P = .019). On the right side of the inflection point (Hb > 10 g/dL), the relationship was not statistically significant (β = 0.001, 95% confidence interval: -0.293 to 0.296, P = .992). In elderly hip fracture patients, there is a nonlinear association between preoperative Hb and LOS. However, when Hb levels were <10 g/dL, there was a negative correlation with the LOS. No correlation was observed when Hb levels were >10 g/dL. These findings underscore the importance of timely intervention to manage Hb levels in elderly patients with hip fractures, potentially reducing hospitalization durations and associated complications.

Evaluation of the Efficacy of Fascia Iliaca Compartment Block in Maintaining Cognitive Function Post-Surgery in Elderly Individuals with Hip Fractures

Postoperative cognitive dysfunction (POCD) is a prevalent issue among elderly hip fracture patients’ post- surgery period, leading to cognitive decline and prolonged recovery. This narrative review delves into the efficacy of Fascia Iliaca Compartment Block (FICB) in addressing POCD. FICB, a targeted anesthetic approach, not only provides efficient pain management but also reduces inflammation and minimizes opioid reliance in the elderly. By alleviating pain and inflammation, FICB facilitates enhanced early postoperative mobility, potentially lowering the likelihood of cognitive dysfunction. Research indicates that FICB can decrease tau protein levels and inflammatory markers, attenuating the inflammatory cascade linked to cognitive impairment. Moreover, FICB's ability to offer localized pain relief without systemic opioid repercussions aids in preventing complications like delirium. The utilization of FICB emerges as a pivotal strategy in optimizing postoperative outcomes and diminishing POCD incidence in elderly hip fracture patients. Further exploration and integration of FICB in clinical practice hold promise for enhancing the care of this vulnerable patient cohort.

Comorbidities, acute kidney injury and long-term mortality in elderly patients hospitalized because of hip fracture: a moderation analysis

IntroductionFemoral fractures in elderly individuals present significant health challenges, often leading to increased morbidity and mortality. Acute kidney injury (AKI) during hospitalization further complicates outcomes, yet the interaction between AKI severity and comorbidities, as quantified by the Charlson Comorbidity Index (CCI), remains poorly understood in this population. This study aimed to assess the associations between AKI severity and the CCI and between AKI severity and one-year mortality postfemoral fracture in elderly patients.MethodologyThis study utilized data from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC-IV) database and focused on elderly patients (> 65 years) admitted with hip fractures. Patients were categorized based on AKI stage according to the KDIGO criteria and CCI scores. The primary outcome assessed was all-cause mortality one year after hospital discharge. The statistical analyses included logistic regression, Cox proportional hazards regression and moderation analysis with the Johnson–Neyman technique to evaluate associations between AKI and long-term mortality and between the CCI and long-term mortality.ResultsThe analysis included 1,955 patients and revealed that severe AKI (stages 2 and 3) was independently associated with increased one-year mortality. Notably, the CCI moderated these associations significantly. A lower CCI score was significantly correlated with greater mortality in patients with severe AKI. The impact of severe AKI was greater for those with a CCI as low as 3, more than doubling the observed one-year mortality rate. In contrast, higher CCI scores (≥8) did not significantly impact mortality. Sensitivity analyses supported these findings, underscoring the robustness of the observed associations.ConclusionThis study elucidates the complex interplay between AKI severity and comorbidities and long-term mortality in elderly hip fracture patients. These findings underscore the importance of considering both AKI severity and comorbidity burden in prognostic assessments and intervention strategies for this vulnerable population. Targeted interventions tailored to individual risk profiles may help mitigate the impact of AKI on mortality outcomes, ultimately improving patient care and outcomes. Further research is warranted to explore the underlying mechanisms involved and refine risk stratification approaches in this population.

Risk factors and prognosis of postoperative acute myocardial infarction in elderly hip fracture patients combined with coronary heart disease

IntroductionThis article mainly studies the risk factors for postoperative acute myocardial infarction (AMI) in elderly hip fracture patients combined with coronary heart disease (CHD), constructs a prediction model, and evaluates the prognosis of all the patients.MethodsThis article retrospectively collected elderly patients with hip fracture and CHD who underwent hip fracture surgery at the Third Hospital of Hebei Medical University from January 2019 to December 2021. Demographic data, laboratory indicators, and imaging examination results were collected from the medical case system. The risk factors of postoperative AMI were determined by univariate and multivariate logistic regression, and a nomogram prediction model was established. The ROC curve, calibration curve and DCA decision curve were plotted by R language software. The patients in the training set were followed up for 2 years to evaluate their survival situation.Results1094 eligible patients were divided into a training set (n = 824 from January 1, 2019 to September 31, 2021) and a validation set (n = 270 from October 1, 2021 to December 31, 2022). In the training set, women accounted for 58.6%; The average age of the patients was 79.45 years old; The main type of fracture was intertrochanteric fracture. There were 64.7% patients taken B receptor blockers; A total of 166 (20.1%) patients underwent percutaneous coronary intervention (PCI); Hypertension accounted for 55.5%; 520 (63.1%) patients had a preoperative waiting time greater than 3 days; The average hemoglobin value upon admission was 101.36 g/L; The average intraoperative bleeding volume was 212.42 ml; The average surgical time was 2.5 ± 0.3 h; Reginal anesthesia accounted for 29.7%; 63 (68.5%) AMI patients had no obvious clinical symptoms; 68 (73.9%) AMI patients did not show ST-segment elevation in ECG; The risk factors of postoperative AMI were age, hemoglobin at admission, diabetes, chronic kidney disease, intraoperative bleeding, and reginal anesthesia. The AUC of the nomogram prediction model was 0.729. The AUC in the validation set was 0.783. Survival analysis showed a significant statistical difference in 2-year mortality between patients with AMI and without AMI, among all the patients with AMI, patients with ECG ST-segment elevation has higher mortality than patients without ECG ST-segment elevation.ConclusionOur research results found that the incidence of postoperative AMI in elderly patients with hip fractures and CHD was 11.1%. Age, diabetes, hemoglobin at admission, regional anesthesia, chronic kidney disease, and intraoperative bleeding are risk factors. The AUC of the nomogram in training set is 0.729. The 2-year mortality rate of the patients with AMI is higher than that of patients without AMI.

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.

Secondary osteoporosis prevention: three-year outcomes from a Fracture Liaison Service in elderly hip fracture patients

BackgroundHip fractures are the most serious fragility fractures due to their associated disability, higher hospitalization costs and high mortality rates. Fracture Liaison Service (FLS) programs have enhanced the management of osteoporosis-related fractures and have shown their clinical effectiveness.AimsTo analyze the effect of the implementation of a FLS model of care over the survival and mortality rates following a hip fracture.MethodsWe conducted a prospective cohort study on patients over 60 years of age who suffered a hip fracture before and after the implementation of the FLS in our center (between January 2016 and December 2019). Patients were followed for three years after the index date. Mortality, complications and refracture rates were compared between the two groups using a Multivariate Cox proportional hazard model.ResultsA total of 1366 patients were included in this study (353 before FLS implementation and 1013 after FLS implementation). Anti-osteoporotic drugs were more frequently prescribed after FLS implementation (79.3% vs 12.5%; p < 0.01) and there was an increase in adherence to treatment (51.7% vs 30.2%; p < 0.01). A total of 413 (40.8%) patients after FLS implementation and 141 (39.9%) individuals before (p = 0.47) died during the three-years follow-up period. A second fracture occurred in 101 (10.0%) patients after FLS implementation and 37 (10.5%) individuals before (p = 0.78). Patients after the implementation of the FLS protocol had a lower all cause one-year mortality [adjusted Hazard Ratio (HR) 0.74 (0.57–0.94)] and a decreased risk of suffering a second osteoporotic fracture [adjusted HR 0.54 (0.39–0.75) in males and adjusted HR 0.46 (0.30–0.71) in females].ConclusionsThe implementation of a FLS protocol was associated with a lower all-cause one-year mortality rate and a higher survivorship in elderly hip fracture patients. However, no three-year mortality rate differences were observed between the two groups. We also found a reduction in the complication and second-fracture rates.

Effect of inflammatory response on joint function after hip fracture in elderly patients: A clinical study

BACKGROUND Excellent hip joint function facilitates limb recovery and improves the quality of survival. This study aimed to investigate the potential risk factors affecting postoperative joint functional activity and outcomes in elderly hip fractures patients and to provide evidence for patient rehabilitation and clinical management. AIM To explore the relationship between inflammatory factors and hip function and the interaction between inflammation and health after hip fracture in elderly patients. METHODS The elderly patients who had hip fracture surgery at our hospital between January 1, 2021, and December 31, 2022 were chosen for this retrospective clinical investigation. Patients with excellent and fair postoperative hip function had their clinical information and characteristics gathered and compared. Age, gender, fracture site, surgical technique, laboratory indices, and other variables that could have an impact on postoperative joint function were all included in a univariate study. To further identify independent risk factors affecting postoperative joint function in hip fractures, risk factors that showed statistical significance in the univariate analysis were then included in a multiple logistic regression analysis. In addition to this, we also compared other outcome variables such as visual analogue scale and length of hospital stay between the two groups. RESULTS A total of 119 elderly patients with hip fractures were included in this study, of whom 37 were male and 82 were female. The results of univariate logistic regression analysis after excluding the interaction of various factors showed that there was a statistically significant difference in interleukin (IL)-6, IL-8, IL-10, C-reactive protein (CRP), and complement C1q (C1q) between the fair and excellent joint function groups (P &lt; 0.05). The results of multiple logistic regression analysis showed that IL-6 &gt; 20 pg/mL [(Odds ratio (OR) 3.070, 95%CI: 1.243-7.579], IL-8 &gt; 21.4 pg/ mL (OR 3.827, 95%CI: 1.498-9.773), CRP &gt; 10 mg/L (OR 2.142, 95%CI: 1.020-4.498) and C1q &gt; 233 mg/L (OR 2.339, 95%CI: 1.094-5.004) were independent risk factors for poor joint function after hip fracture surgery (all P &lt; 0.05). CONCLUSION After hip fractures in older patients, inflammatory variables are risk factors for fair joint function; therefore, early intervention to address these markers is essential to enhance joint function and avoid consequences.

Predictive value of the systemic immune-inflammation index on one-year mortality in geriatric hip fractures.

Geriatric hip fractures are associated with a high incidence of mortality. This study examines the predictive value of the systemic immune-inflammation index (SII) on one-year mortality in elderly hip fracture patients. A single-center retrospective study was conducted between February 2017 and October 2020. Three hundred and eleven surgically treated consecutive hip fracture patients were included in the study. Admission, postoperative first day, and postoperative fifth-day SII values were calculated. The receiver operating characteristic (ROC) curve was used to calculate the cut-off values, and patients were divided into high and low groups according to these cut-off values. After univariate Cox regression analysis, significant factors were included in the multivariate Cox proportional hazards model to adjust the effect of covariates and explore independent predictive factors associated with mortality. Further subgroup analysis was performed to evaluate the accuracy of the results for different clinical and biological characteristics. The mean age was 80.7 ± 8.0 years, and women made up the majority (67.8%) of the patients. The one-year mortality rate was 28.0%. After univariate and multivariate analyses, high postoperative fifth-day SII remained an independent predictor of one-year mortality (adjusted HR 2.16, 95% CI 1.38-3.38, p = 0.001). Older age, male gender, Charlson comorbidity index (CCI) ≥ 2, and hypoalbuminemia were found to be other independent predictors. The optimal cut-off value of the postoperative fifth-day SII was calculated at 1751.9 units (p < 0.001). The postoperative fifth-day SII is a simple and useful inflammatory biomarker for predicting one-year mortality in patients with hip fracture.

Orthogeriatric Care Following Hip Fracture: Improving Post-Operative Outcomes in an Aged Population.

Hip fractures globally are associated with high levels of morbidity, mortality, and significant financial burden. This audit aimed to assess the impact of orthogeriatric liaison care on post-operative outcomes following surgical management of neck or femur fractures. Here, 258 patients who underwent hip fracture surgery over 1-year were included. Data were collected as an audit following the transition to an orthogeriatric liaison care model, involving regular orthogeriatric review (thrice weekly ward rounds, daily board rounds), superseding orthogeriatric review as requested. The audit is meant to assess the development of post-operative non-surgical site infection (NSSI) and mortality and duration of inpatient stay. Outcomes were compared to previous data from our hospital site in 2015/2016. Patients with severe cognitive impairment and systemic disease (Abbreviated Mental Test Score (AMTS) < 7 and American Society of Anesthesiologists (ASA) grade ≥ 3) showed significantly elevated NSSI risk, consistent across the study periods. Both periods demonstrated an increased risk of NSSI associated with admission from nursing homes. Despite the 2021/2022 cohort being notably older, NSSI risk decreased from 40.6% to 37.2% after implementing the orthogeriatric care model. NSSI risk was notably reduced for severe cognitive impairment (51.6% vs. 71%), and the p-value was 0.025. Average hospital stay decreased post-intervention (2.4 days shorter), with a notable reduction for NSSI patients (3.4 days shorter). Overall mortality rates were similar, although mortality due to infection was significantly reduced in 2021/2022 (44.4% vs. 93.3%), and the p-value was 0.003. The orthogeriatric liaison care model significantly decreased NSSI only in individuals with severe cognitive impairment and infection-associated mortality. This highlights the integral role of orthogeriatricians in the care of elderly hip fracture patients.

Non-linear relationship between preoperative albumin-globulin ratio and postoperative pneumonia in patients with hip fracture

Background and objectivePostoperative pneumonia (POP) is the leading cause of death among patients with hip fractures. Simple and cost-effective markers can be used to assess the risk of these patients. This study aims to investigate the association between POP and preoperative albumin-globulin ratio (AGR) in patients with hip fractures. MethodsA retrospective analysis was conducted on data from 1417 hip fracture patients admitted to the Department of Orthopaedics at the hospital. Generalized additive and logistic regression models were used to determine both linear and non-linear associations between preoperative AGR and POP. A two-piece regression model was employed to determine the threshold effect. ResultsThe study included 1417 participants, with a mean age of 77.57 (8.53) years and 26.96% (382/1417) male patients. The prevalence of POP was 6.21%. Following full covariate adjustment, each unit increase in AGR was associated with a 79% reduction in the incidence of POP (OR, 0.23; 95% CI: 0.08–0.63; P = 0.0046). The inflection point was found to be 1.33 using a two-piecewise regression model. For each unit increase in AGR on the left side of the inflection point, the incidence of POP decreased by 93% (OR, 0.07; 95%CI: 0.02–0.34; P = 0.0010). However, there was no statistically significant correlation on the right side of the inflection point (OR, 0.84; 95% CI: 0.17–4.10; P = 0.8287). ConclusionThere exists a non-linear association between preoperative AGR and the incidence of POP in elderly hip fracture patients. When AGR is less than 1.33, the incidence of POP is negatively correlated with AGR. However, there is no correlation when AGR is greater than 1.33.

Association between admission albumin levels and 30-day readmission after hip fracture surgery in geriatric patients: a propensity score-matched study

PurposeThis study aimed to evaluate the correlation admission albumin levels and 30-day readmission after hip fracture surgery in geriatric patients.MethodsIn this retrospective cohort study, 1270 geriatric patients admitted for hip fractures to a level I trauma center were included. Patients were stratified by clinical thresholds and albumin level quartiles. The association between admission albumin levels and 30-day readmission risk was assessed using multivariate logistic regression and propensity score-matched analyses. The predictive accuracy of albumin levels for readmission was evaluated by ROC curves. The dose–response relationship between albumin levels and readmission risk was examined. ResultsThe incidence of 30-day readmission was significantly higher among hypoalbuminemia patients than those with normal albumin levels (OR = 2.090, 95%CI:1.296–3.370, p = 0.003). Furthermore, propensity score-matched analyses demonstrated that patients in the Q2(35.0–37.9 g/L) (OR 0.621, 95%CI 0.370–1.041, p = 0.070), Q3(38.0–40.9 g/L) (OR 0.378, 95%CI 0.199–0.717, p < 0.001) and Q4 (≥ 41 g/L) (OR 0.465, 95%CI 0.211–0.859, p = 0.047) quartiles had a significantly lower risk of 30-day readmission compared to those in the Q1(< 35 g/L) quartile. These associations remained significant after propensity score matching (PSM) and subgroup analyses. Dose–response relationships between albumin levels and 30-day readmission were observed.ConclusionsLower admission albumin levels were independently associated with higher 30-day readmission rates in elderly hip fracture patients. Our findings indicate that serum albumin may assist perioperative risk assessment, and prompt correction of hypoalbuminemia and malnutrition could reduce short-term readmissions after hip fracture surgery in this high-risk population.

Prevalence of preoperative delirium and associated factors in elderly hip fracture patients at King Chulalongkorn Memorial Hospital

Prevalence of preoperative delirium and associated factors in elderly hip fracture patients at King Chulalongkorn Memorial Hospital

Post-operative complications in elderly patients undergoing hip fracture surgery: An observational study

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.

Promoting cemented fixation of the femoral stem in elderly female hip arthroplasty patients and elderly hip fracture patients: a retrospective cohort study from the Norwegian Arthroplasty Register and the Norwegian Hip Fracture Register.

Uncemented stems increase the risk of revision in elderly patients. In 2018, we initiated a national quality improvement project aiming to increase the proportion of cemented stems in elderly female total hip arthroplasty (THA) and hip fracture hemiarthroplasty (HA) patients. We aimed to evaluate the association of this project on the frequency of cemented stems and the risk of secondary procedures in the targeted population. 10,815 THAs in female patients ≥ 75 years in the Norwegian Arthroplasty Register and 19,017 HAs in hip fracture patients ≥ 70 years in the Norwegian Hip Fracture Register performed in 2015-2017 and 2019-2021 at all Norwegian hospitals were included in this retrospective cohort study. The quality improvement project was implemented at 19 hospitals (8,443 patients). 1-year revision risk (THAs) and reoperation risk (HAs) were calculated for uncemented and cemented stems by Kaplan-Meier and Cox adjusted hazard rate ratios (aHRRs) with all-cause revision/reoperation as main endpoint. The use of cemented stem fixation in the targeted population increased from 26% to 80% for THAs and from 27% to 91% for HAs. For THAs, the 1-year revision rate decreased from 3.7% in 2015-2017 to 2.1% in 2019-2021 (aHRR 0.7, 95% confidence interval [CI] 0.5-0.9) at the intervention hospitals. For HAs, the reoperation rate decreased from 5.9% in 2015-2017 to 3.3% in 2019-2021 (aHRR 0.6, CI 0.4-0.8) at the intervention hospitals. The quality improvement project resulted in a significant increase in the proportion of cemented stems and reduced risk of secondary procedures for both THAs and HAs.