Partial Hip Replacement Research Articles

A Gender-based Study on the Morphometry of Cotyloid Cavity of the Coxal Bone in South Indian Population

Abstract Background and Aim: The cotyloid cavity (acetabulum) is a cup-shaped hollow on the lateral aspect of the coxal bone. The head of the femur articulates with cotyloid cavity to form the hip joint. The cotyloid cavity varies in size, shape, and depth among individuals. Any deviation from the normal range of parameters of the acetabulum may result in arthrosis-related pathologies. Materials and Methods: The present study was conducted on 200 dry human hip bones. The bones were collected from the department of anatomy of a medical college in Mangalore. The following morphometrical parameters of the cotyloid cavity were measured: (a) transverse diameter of acetabulum, (b) acetabular height, (c) acetabular depth, (d) acetabular volume, (e) distance from the pubic tubercle to the anterior rim of the acetabulum, and (f) ratio between distance from the pubic tubercle to the anterior rim of the acetabulum and acetabular height. Range, mean, standard deviation, and standard error of mean were determined for each parameter. P value was also calculated. Gender-wise comparison of the results was done. Results: The independent t-test was done, and the P value was calculated for each parameter. All the parameters showed significant differences between the male and female hip bones. Conclusion: In this modern era, total and partial hip replacement surgeries are very commonly performed. Therefore, knowledge regarding the various morphometrical parameters of the cotyloid cavity may be of great help in the preoperative planning period. It would also be of great help in the fields of forensic anthropology, osteology, and anatomy.

Comparison of clinical results of flattapered and rectangular stems in partial hip replacement based on proximal femur fracture

Aim: Hemiarthroplasty is commonly used in proximal femur fractures to provide early mobilization and weight bearing to the patient. Cemented and cementless femoral stems are commonly used in this procedure. Cementless prostheses have many advantages and disadvantages, and their relevance to stem design is controversial. This study aimed to compare flat-tapered and rectangular femoral stems in hemiarthroplasty. Methods: The study population consisted of a third-level hospital’s archive orthopedics and traumatology clinic. Our study was retrospective. A total of 176 patients who underwent cementless hemiarthroplasty in proximal femoral fractures between January 2017 and January 2022 were included in the study. Within these protocols, 64 patients underwent hemiarthroplasty using a flat-tapered stem (Group 1), and 58 patients underwent hemiarthroplasty using a rectangular stem (Group 2). At the last follow-up of the patients, the Harris hip score, Visual Analogue Scale, and early and long-term complications were evaluated. Results: No significant differences among the patients were observed regarding Harris hip scores and Visual Analogue Scale values. The study groups were analyzed in terms of developing complications. Similar results were found in both groups regarding periprosthetic femur fractures. Conclusion: Our study found no significant difference between flat-tapered and rectangular stems in terms of clinical outcomes and periprosthetic femur fracture in cases of cementless hemiarthroplasty. As a result, rectangular stems can be safely preferred in hemiarthroplasty.

Postoperative pneumonia after femoral fracture surgery: an in-depth retrospective analysis

BackgroundFemoral fractures significantly contribute to disability, predominantly in the elderly. Despite this, data on postoperative pneumonia following femoral fracture surgeries remains sparse. Our study sought to explore the incidence and impact of postoperative pneumonia on outcomes following such surgeries.MethodsA retrospective study analyzed femoral fracture patients hospitalized from 2016 to 2022. We scrutinized postoperative outcomes, including pneumonia, hospital stay duration, intensive care unit (ICU) admissions, and in-hospital mortality. We established stringent diagnostic criteria for postoperative pneumonia, incorporating both clinical signs and radiological evidence, excluding patients with prior infections or those discharged within 24 h post-surgery. Statistical analyses involved Chi-square and t-tests, linear regression, and logestic regression using SPSS.ResultsOut of 636 patients, 10.8% were diagnosed with postoperative pneumonia. The average age was 79.55 ± 8.57 years, with a male prevalence of 47.8%. Common comorbidities were hypertension (78.3%), diabetes (60.9%), and cardiovascular diseases (40.6%). Surgical interventions were categorized as intramedullary nailing (40.6%), partial hip replacement (37.7%), and dynamic hip screw (21.7%). Postoperative pneumonia was associated with older age (AOR = 1.053, 95% CI 1.020 to 1.087, p = 0.002), ICU admission (AOR = 2.283, 95% CI 1.256 to 4.148, p = 0.007), and longer length of hospital stay (AOR = 1.079, 95% CI 1.030 to 1.130, p = 0.001). The presence of pneumonia was associated with a 2.621-day increase in hospitalization after adjusting for other variables (p < 0.001, 95% CI: 1.454 to 3.789).ConclusionThis study accentuates the clinical significance of postoperative pneumonia in femoral fracture patients, with a noted incidence of 10.8%. A notable association with older age, prolonged hospital stays, and ICU admissions was observed, underscoring the necessity of addressing this complication to improve patient outcomes and healthcare resource allocation.

Avaliação do tratamento cirúrgico de pacientes acima de 90 anos com fraturas de quadril e sua morbimortalidade

Resumo Objetivo: As fraturas de quadril em idosos são as que mais impactam na saúde do paciente e estão associadas a muitas complicações, levando a redução da capacidade funcional, da qualidade de vida e da expectativa de vida. O nosso trabalho visa trazer mais dados epidemiológicos sobre os desfechos dessas fraturas em nonagenários em uma grande cidade atendidos em um hospital terciário. Métodos: O trabalho foi realizado através de revisão de prontuários e entrevistas. Resultados: Foram realizadas 82 cirurgias em 76 pacientes nesse período. A média de idade foi de 92,5 anos, 90% eram mulheres e ficaram 10,4 dias internados. A cirurgia foi realizada em média 2,3 dias após a internação. Do total, 46 fraturas foram trocantéricas (56%) e 34 do colo do fêmur (41,5%). Foram realizadas 41 cirurgias com a técnica da haste cefalomedular curta (50%) e 18 artroplastias parcial de quadril (22%). Durante a internação, 46 pacientes (55%) não apresentaram complicações, excluindo episódios de delirium, e 7 pacientes (9% dos casos) evoluíram para óbito. 42 pacientes já fecharam 1 ano após cirurgia: 56% estão vivos e 44% evoluíram para óbito. Conclusões: O tratamento de fraturas de quadril em pacientes idosos é desafiador. O nosso objetivo deve estar focado em ajudar esses idosos a receber um tratamento rápido e menos agressivo possível e a mobilizar precocemente. Esperamos que, com os dados apresentados nesse trabalho, possamos entender melhor acerca das características da nossa população nonagenária vítimas de fratura de quadril e buscar o melhor tratamento possível para esses pacientes.

Anesthesia in Low Ejection Fraction Patient : Case Report

Ejection fraction (EF) is the percentage of the difference between the end-diastolic volume and the end-systolic volume divided by the end-diastolic volume. This measurement is important in determining how well the heart is pumping out blood and in diagnosing heart failure (HF). Normally the percentage of EF is above 50%. A decrease in EF will make it difficult to perform anesthesia during surgery due to life-threatening irregular heartbeats, leading to sudden cardiac arrest and sudden death. Patients with a very low ejection fraction require identification of risk factors, preoperative evaluation and optimization, medical therapy, monitoring, and appropriate anesthetic technique and drugs. In this report, we present a 67-year-old woman with HFmrEF (estimated ejection fraction 46%) and coronary artery disease who underwent partial hip replacement surgery under general anesthesia. General anesthesia was performed on the patient and induction used fentanyl, midazolam, and atracurium. Management of patients is aimed at maintaining cardiac output and avoiding myocardial depression by maintaining a balance between oxygen supply and demand. Therefore good anesthetic management is needed to maintain the hemodynamic stability of the patient.

Morphometrical parameters of acetabulum of hip bone - An osteological study

Background: Acetabulum is an approximately hemispherical cavity on the lateral aspect of the hip bone. Acetabulum is not always of the same shape, size, or depth. Any deviations of the parameters from normal range have strong correlation with the development of various kinds of pathologies. Aims and Objectives: Acetabulum is an approximately hemispherical cavity on the lateral aspect of the hip bone. Acetabulum is not always of the same shape, size or depth. Any deviations of the parameters from normal range have strong correlation with the development of various kinds of pathologies. Materials and Methods: This study was conducted in department of Anatomy, Yenepoya Medical College, Mangalore. Two hundred hip bones were included in the study. Various parameters of the acetabulum were measured. The morphometrical parameters measured were: (a) Transverse diameter of acetabulum, (b) acetabular height, (c) acetabular depth, (d) acetabular volume, (e) distance from pubic tubercle to anterior rim of acetabulum, (f) ratio between distance from pubic tubercle to anterior rim of acetabulum and acetabular height. Range, mean, standard deviation, and standard error of mean were determined for each parameter. P value was also calculated to compare the parameters side wise. Results: The independent T test was done and the P value was calculated for each parameter. Acetabular volume showed a significant difference between left- and right-sided bones. Most of the parameters showed highly significant difference between male and female hip bones in both right side and left side. Conclusion: As total and partial hip replacements are common surgeries performed these days, knowledge of the dimensions of acetabulum will assist prosthetists to construct suitable prosthesis for Indian population. It would be also useful in the fields of anatomy, osteology, and anthropology.

Leg Length Discrepancy After Hip Fracture Repair is Associated With Reduced Gait Speed.

A negative correlation exists between functional outcomes and leg length discrepancy (LLD) following hip fracture repair. We have assessed the effects of LLD following hip fracture repair in elderly patients on 3-meter walking time, standing time, activities of daily living (ADL), and instrumental activities of daily living (IADL). One hundred sixty-nine patients enrolled in the STRIDE trial were identified with femoral neck, intertrochanteric, and subtrochanteric fractures that were treated with partial hip replacement, total hip replacement, cannulated screws, or intramedullary nail. Baseline patient characteristics recorded included age, sex, body mass index Charlson comorbidity index (CCI) score. ADL, IADL, grip strength, sit-to-stand time, 3-meter walking time and return to ambulation status were measured at 1 year after surgery. LLD was measured on final follow-up radiographs by either the sliding screw telescoping distance or the difference from a trans-ischial line to the lesser trochanters, and was analyzed as a continuous variable using regression analysis. Eighty eight patients (52%) had LLD <5mm, 55 (33%) between 5-10mm and 26 subjects (15%) >10mm. Age, sex, BMI, Charlson score, and ambulation status had no significant impact on LLD occurrence. Type of procedure and fracture type did not correlate with severity of LLD. Having a larger LLD was not found to have a significant impact on post-operative ADL (P = .60), IADL (P = .08), sit-to-stand time (P = .90), grip strength (P = .14) and return to former ambulation status (P = .60), but did have a statistically significant impact on 3-meter walking time (P = .006). LLD after hip fracture was associated with reduced gait speed but did not affect many parameters associated with recovery. Continued efforts to restore leg length after hip fracture repair are likely to be beneficial.

Preoperative and intraoperative risk factors for acute kidney injury after hip fracture surgery: a cohort retrospective study

Introduction Hip fractures have several adverse effects on patients’ morbidity and mortality. Postoperative Acute kidney injury (AKI) is one of the complications that have a significant impact on the patient’s overall prognosis. We aimed to identify AKI risk after hip fracture surgery and the preoperative and intraoperative risk factors. Methodology We conducted a retrospective cohort study in a tertiary care hospital on adult patients who underwent surgery for hip fractures between January 2015 and August 2021. All clinical data were reviewed. Result A total of 611 patients were included (age = 76.44 ± 9.69 years). 126 (20.6%) of them developed AKI postoperatively. In multilinear logistic regression analysis, factors associated with postoperative AKI included eGFR [odds ratio (OR): 0.98; 95% confidence interval (CI): 0.97–0.99 with a p value .01], spinal anesthesia [OR: 1.78; 95% CI: 1.1–2.9 with a p value .01], and partial hip replacement (PHR) type of surgery [OR: 0.56; 95% CI: 0.32–0.96 with a p value .036]. The development of postoperative AKI was the strongest factor that increase mortality of the patients as the (HR = 2.42, CI 95% [1.57–3.74]; p value <.001). Conclusion In this study, we highlight that lower eGFR, and spinal anesthesia were associated with a higher risk of AKI, and PHR surgery has lower odds to develop AKI. Postoperative AKI is associated with a higher mortality rate after hip fracture surgery.

Profile of Patients’ Osteoarthritis at Tertiary and Teaching in Aceh, Indonesia

Background: Osteoarthritis is a degenerative joint disease characterized by damage of cartilage in the joints and subchondral bones that cause pain in a joint. Aim: To describe the patients’ profile of osteoarthritis at the Dr Zainoel Abidin Hospital Banda Aceh. Material and Methods: A retrospective observational descriptive study on osteoarthritis patients who were treated at the Orthopaedic Clinic of RSUDZA Banda Aceh for the period March 2020 to February 2022. Results: Two years of observation yielded a total of 397 osteoarthritis patients. Most cases are in female patients (63.4%), with the majority of those in the age bracket &gt;55 years (61.9%), with the majority of patients being from Banda Aceh City (37.2%). The most diagnoses are knee OA, which is 330 patients (82.9%) and hip OA, which is 39 patients (9.9%). Only 108 patients received surgery, operations for knee OA, total knee replacement were 78 patients (23.63%), while for hip OA patients who needed total hip teplacement surgery there were were 26 patients (66.66%) and partial hip replacement was 4 patients (10.25%). Conclusion: Osteoarthritis often occurs in female patients and mostly in the patient age group &gt;55 years. Indications for surgery in OA are based on symptoms, stage of OA, and patient-related factors such as age, level of physical activity, and patient comorbidities.

A systematic review and meta-analysis comparing intrawound vancomycin powder and povidone iodine lavage in the prevention of periprosthetic joint infection of hip and knee arthroplasties

BackgroundFocus on reviewing a vigorous research effort to improve the safety profile of vancomycin powder (VP) and its optimal dose in reducing periprosthetic joint infection (PJI) is the need of the hour. This systematic review and meta-analysis attempt to explore the ongoing use of VP and VP + povidone iodine (PI) lavage to prevent PJI of hip/knee arthroplasties and highlights its challenges among the orthopedic community about the existence of the major organism and its frequency in total joint arthroplasty (TJA) patients. MethodsWe searched PubMed/MEDLINE, EMBASE databases regarding the outcomes of vancomycin powder (VP) and VP + povidone iodine (PI) combination in preventing periprosthetic joint infection of hip and knee arthroplasties. ResultsIn 5 of 7 studies, the combination of vancomycin powder (VP) and povidone iodine (PI) lavage have shown a lower risk of periprosthetic joint infection (PJI) in acute and high-risk hip and knee arthroplasties patients, with less or without serious adverse events and readmissions; while four of seven studies using VP-only found increasing rates of PJI in primary total knee arthroplasty and partial hip replacement in elderly patients with comorbidities, and significantly causes aseptic wound complications compared to the control group. ConclusionsIntra-articular vancomycin powder (VP) and povidone iodine (PI) lavage showed a significant reduction of periprosthetic joint infection in primary and revision total joint arthroplasty. Before its widespread use in clinical settings, prospective randomized studies and, most importantly, its long-term efficacy and safety are recommended.

Evaluation of risk factors and outcomes associated with mortality after hip fracture surgery in eldery patients

Objective: In this retrospective study, it was aimed to compare mortality related risk factors and outcomes in patients who underwent proximal femoral nail and partial hip prosthesis for hip fracture.&#x0D; Material and Method: In our study, a total of 618 patient files who underwent hip fracture operations, including partial hip replacement (n=350) and proximal femoral nail (n=268) were retrospectively analyzed. Age, gender, fracture side, cause, type of fracture, type of operation, blood transfusion, hospital stay, anesthesia type and one-year survival times of the patients were examined.&#x0D; Results: Gender, age, side, mechanism, anesthesia, comorbid diseases, cause of mortality, one-year mortality and survival time differences between patient groups were not statistically significant (p&gt;0.05). However, fracture type, blood transfusion and hospital stay differences between groups were statistically significant (p

Higher cost of arthroplasty for hip fractures in patients transferred from outside hospitals vs primary emergency department presentation.

BACKGROUNDIn 2016 Centers for Medicare and Medicaid Services proposed bundled payments for hip fractures to improve the quality and decrease costs of care. Patients transferred from other facilities may be imposing a financial risk on the hospitals that accept these patients. AIMTo determine the costs associated with patients that either presented to the emergency department or were transferred from another hospital or skilled nursing facility (SNF) with the diagnosis of a hip fracture requiring operative intervention.METHODSA retrospective single institution review was conducted for all arthroplasty patients from 2010 to 2015. Inclusion criteria included a total or partial hip replacement for a hip fracture. Exclusion criteria included pathologic, periprosthetic, and fracture non-union. Data was collected to compare total observed costs for patients from the emergency department, patients from skilled nursing facilities, and patients from an outside hospital.RESULTSA total of 223 patients met the inclusion criteria. 135 (60.54%) of these patients presented primarily to the emergency department, 58 patients (26.01%) were transferred from an outside hospital, and 30 patients (13.43%) were transferred from a SNF. Cost data analysis showed that outside hospital patients demonstrated significantly greater total cost for their hospitalization ($43302) compared to emergency department patients ($28875, P = 0.000) and SNF patients ($28282, P = 0.000).CONCLUSIONPatients transferred from an outside hospital incurred greater costs for their hospitalization than patients presenting from an emergency department or SNF. This is a strong argument for risk-adjustment models when bundling payments for the care of hip fracture patients.

Management of Proximal Femoral Fractures

Abstract Proximal femoral fractures are typical injuries in the elderly population. We conducted a retrospective study to estimate postoperative mortality and risk factors affecting patient outcomes at Tartu University Hospital. We retrospectively evaluated patients who were hospitalised in 2017 with a proximal femoral fracture diagnosis and who were operated (osteosynthesis, partial and total hip replacement). In the study we included 313 patients of 361 (219 women and 94 men). We did not find statistically significant difference between the choice of anaesthesia and mortality or between the time getting to the OR and mortality. Cognitive impairment and postoperative delirium were significantly associated with increased one-year mortality was 37% (p &lt; 0.05). In the group of the patients who did not have postoperative delirium the overall mortality was 15%. 23% of the patients had preoperatively cognitive impairment, and 45.8% of them died in the first year after the operation (p &lt; 0.001). Mortality of patients who did not have cognitive impairment was 14%. As the sample group of patients included in the study was small, further investigation should encompass a larger group in the future.

Anaesthetic choice for hip or knee arthroplasty in New Zealand: Risk of postoperative death and variations in use.

Anaesthetic choice for large joint surgery can impact postoperative outcomes, including mortality. The extent to which the impact of anaesthetic choice on postoperative mortality varies within patient populations and the extent to which anaesthetic choice is changing over time remain under-explored both internationally and in the diverse New Zealand context. In a national study of 199,211 hip and knee replacement procedures conducted between 2005 and 2017, we compared postoperative mortality among those receiving general, regional or general plus regional anaesthesia. Focusing on unilateral (n=86,467) and partial (n=13,889) hip replacements, we assessed whether some groups within the population are more likely to receive general, regional or general plus regional anaesthesia than others, and whether mortality risk varies depending on anaesthetic choice. We also examined temporal changes in anaesthetic choice over time. Those receiving regional alone or general plus regional for unilateral hip replacement appeared at increased risk of 30-day mortality compared to general anaesthesia alone, even after adjusting for differences in terms of age, ethnicity, deprivation, rurality, comorbidity, American Society of Anesthesiologists physical status score and admission type (e.g. general plus regional: adjusted hazard ratio (adj. HR)=1.94, 95% confidence intervals (CI) 1.32 to 2.84). By contrast, we observed lower 30-day mortality among those receiving regional anaesthesia alone compared to general alone for partial hip replacement (adj. HR=0.86, 95% CI 0.75 to 0.97). The latter observation contrasts with declining temporal trends in the use of regional anaesthesia alone for partial hip replacement procedures. However, we recognise that postoperative mortality is one perioperative factor that drives anaesthetic choice.

Sarcopenia Diagnosis: Reliability of the Ultrasound Assessment of the Tibialis Anterior Muscle as an Alternative Evaluation Tool.

Sarcopenia is a skeletal muscle disorder characterized by reduced muscle mass, strength, and performance. Muscle ultrasound can be helpful in assessing muscle mass, quality, and architecture, and thus possibly useful for diagnosing or screening sarcopenia. The objective of this study was to evaluate the reliability of ultrasound assessment of tibialis anterior muscle in sarcopenia diagnosis. We included subjects undergoing total or partial hip replacement, comparing measures with a healthy control group. We measured the following parameters: tibialis anterior muscle thickness, echogenicity, architecture, stiffness, skeletal muscle index (SMI), hand grip strength, and sarcopenia related quality of life evaluated through the SarQoL questionnaire. We included 33 participants with a mean age of 54.97 ± 23.91 years. In the study group we found reduced tibialis anterior muscle thickness compared to the healthy control group (19.49 ± 4.92 vs. 28.94 ± 3.63 mm, p < 0.05) with significant correlation with SarQoL values (r = 0.80, p < 0.05), dynamometer hand strength (r = 0.72, p < 0.05) and SMI (r = 0.76, p < 0.05). Moreover, we found reduced stiffness (32.21 ± 12.31 vs. 27.07 ± 8.04 Kpa, p < 0.05). AUC measures of ROC curves were 0.89 predicting reduced muscle strength, and 0.97 predicting reduced SMI for tibialis anterior muscle thickness, while they were 0.73 and 0.85, respectively, for muscle stiffness. Our findings showed that ultrasound assessment of tibialis anterior muscle might be considered a reliable measurement tool to evaluate sarcopenia.

Effects of a modified muscle sparing posterior technique in hip hemiarthroplasty for displaced intracapsular fractures on postoperative function compared to a standard lateral approach (HemiSPAIRE): protocol for a randomised controlled trial

IntroductionCurrently National Institute for Health and Care Excellence clinical guidelines in the UK suggest that surgeons performing partial hip replacements (hemiarthroplasty) should consider using the lateral approach. Alternatively, a newer,...

Cost of Osteoporosis-Related Hip Fractures in a Private Tertiary Hospital System

Background: Osteoporotic fractures, especially of the hip, lead to great burden both for the patient and economy. Due to the paucity of burden of illness studies of osteoporosis in the Asian region, particularly the Philippines, it is difficult to allocate healthcare resources appropriately for fracture prevention. The availability of information on the financial burden of osteoporosis-related fractures, particularly in the local region, will create awareness of the size of the problem as well as assist healthcare authorities to initiate appropriate programs and strategies. Objective: to determine the cost of osteoporosis-related hip fractures in a private tertiary hospital. Methods: Data from the medical records of patients diagnosed with osteoporosis-related hip fractures who were hospitalized from January 1, 2017- December 31, 2019 were analyzed. The researcher recorded the patient’s demographic data, type of hip fracture, type of treatment, duration of hospitalization, and medical costs. Descriptive statistics, t-test, chi-squared test, ANOVA with Tukey HSD test and regression analysis were employed to treat and analyze the different sets of data. Results: Among the 150 patients, 44.6% were within the 80-year-old and above age group and majority (76%) were females. The most common type of osteoporotic hip fracture involved the femoral neck (52.7%) and most of the patients underwent partial hip replacement (66%). Patients 80 and above age group, those sustaining an intertrochanteric fracture and those who were treated with internal fixation had a longer length of stay in the hospital. There was note of a parallel increase in the direct medical cost as the patients age group got older. It was found that femoral neck fracture had significantly higher implant costs while the other costs (hospitalization, surgery, laboratories, and medications) were observed to be comparable between the two types of fracture. Conclusions: The overall mean cost of osteoporotic hip fracture was 5227.78 USD. The implant used on average accounted for approximately 27% of the total direct medical costs. It was noted that 26% and 23% of the total cost was attributed to the cost of surgery and hospitalization respectively. Medication costs accounted for 11% while laboratory costs comprised 13% of total costs.

Relationship Between Nursing Home Compare Improvement in Function Quality Measure and Physical Recovery After Hip Replacement

ObjectiveTo determine whether patients with a total or partial hip replacement admitted to a skilled nursing facility (SNF) after the improvement in function quality measure was added to Nursing Home Compare in July 2016 have greater physical recovery than patients admitted before July 2016. DesignPre (January 1, 2015-June 30, 2016) vs post (July 1, 2016-December 31, 2017) design. SettingSkilled nursing facilities (n=12,829). ParticipantsMedicare fee-for-service beneficiaries (N=106,832) discharged from acute hospitals to SNF after hip replacement between January 1, 2015 and December 31, 2017. InterventionsNot applicable. Main Outcome MeasuresThe 5- and 14-day minimum data set assessments were used to calculate total scores for the quality measure, self-care, mobility, and balance. We calculated the average adjusted change per 10 days and any improvement between the 5- and 14-day assessments. ResultsThe average adjusted change per 10 days for the quality measure total score for patients admitted before July 2016 and after July 2016 was 1.00 points (standard error, 0010) and 1.06 points (standard error, 0.010), respectively (P<.01). This was a relative increase of 6.0%. Among patients admitted to a SNF before July 2016, 44.4% (standard error, 0.06) had any improvement in the quality measure total score compared with 45.5% (standard error, 0.23) of patients admitted after July 2016 (P<.01). This was a relative increase of 2.5%. The adjusted change per 10 days and percentage of patients who had any improvement in the total scores for self-care, mobility, and balance were all significantly higher after July 2016. ConclusionsPatients admitted to a SNF after a hip replacement after July 2016 had greater physical recovery than patients admitted before the improvement in function quality measure was added to Nursing Home Compare.

Cost Determinants of Continuum-Care Episodes for Hip Fracture.

Many factors affect the healthcare costs and outcomes in patients with hip fracture (HF). Through the construction of a Continuum-Care Episode (CCE), we investigated the costs of CCEs for HF and their determinants. We used data extracted from administrative databases of 5094 consecutive elderly patients hospitalized in 2017 in Emilia Romagna, Italy, to evaluate the overall costs of the CCE. We calculated the acute and post-acute costs from the date of the hospital admission to the end of the CCE. The determinants of costs by type of surgical intervention (total hip replacement, partial hip replacement, open reduction, and internal fixation) were investigated using generalized linear regression models. Regardless of the type of surgical intervention, hospital bed-based rehabilitation in public or private healthcare facilities either followed by rehabilitation in a community hospital/temporary nursing home beds or not were the strongest determinants of costs, while rehabilitation in intermediate care facilities alone was associated with lower costs. CCE’s cost and its variability is mainly related to the rehabilitation setting. Cost-wise, intermediate care resulted to be an appropriate setting for providing post-acute rehabilitation for HF, representing the one associated with lower overall costs. Intermediate care organizational setting should be privileged when planning integrated care HF pathways.

Effects of the elixhauser comorbidity index on the time of discharge and 30-day mortality rate in geriatric and non-geriatric patients undergoing partial hip prosthesis arthroplasty

In this study, we aimed to analyse the non-routine discharge period of the ECI and its predicted effect on the 30-day mortality rate in geriatric and non-geriatric patients admitted for partial hip replacement. 215 patients who underwent elective partial hip arthroplasty under spinal anaesthesia in our tertiary hospital were included in the study. This was a single-centre retrospective descriptive study. Data were collected by reviewing the electronic patient data system and patient files. The patients were divided into two groups as non-geriatric (18-64-year-old, n=125) and geriatric (≥65-year-old, n=90). The impact of the Elixhauser Comorbidity Index (ECI) on postoperative mortality rates and the discharge time from the hospital was analysed by comparing the age groups. The ECI percentage values (80.86 ± 3.99) of recovered patients were higher than patients discharged as exitus (71.5 ± 7.74) (p 0.05). When ECI≤77.8%, it predicts mortality with 77.8% sensitivity and 85.92% specificity. The Elixhauser Comorbidity index could not predict the time of discharge due to complications developed after transfer of patients to the postoperative intensive care unit. There was no significant correlation between ECI and discharge time in non-geriatric and geriatric patients.