Sustained Hip Fractures Research Articles

Facilitating clinical trials in hip fracture in the UK : the role and potential of the National Hip Fracture Database and routinely collected data.

The aim of this study was to evaluate the suitability, against an accepted international standard, of a linked hip fracture registry and routinely collected administrative dataset in England to embed and deliver randomized controlled trials (RCTs). First, a bespoke cohort of individuals sustaining hip fractures between 2011 and 2016 was generated from the National Hip Fracture Database (NHFD) and linked to individual Hospital Episode Statistics (HES) records and mortality data. Second, in order to explore the availability and distribution of outcomes available in linked HES-Office of National Statistics (ONS) data, a more contemporary cohort with incident hip fracture was identified within HES between January 2014 and December 2018. Distributions of the outcomes within the HES-ONS dataset were reported using standard statistical summaries; descriptive characteristics of the NHFD and linked HES-ONS dataset were reported in line with the Clinical Trials Transformation Initiative recommendations for registry-enabled trials. Case ascertainment of the NHFD likely exceeds 94%. The assessment of the robustness, relevance, and reliability of the datasets was favourable. Outcomes from the HES-ONS dataset were concordant with other contemporaneous prospective cohort studies with bespoke data collection frameworks. Our findings support the feasibility of the NHFD and HES-ONS to support a registry-embedded, data-enabled RCT.

Is decreased psoas volume a risk factor for hip fracture? A comparative study of patients with and without hip fractures using the exact matching technique

IntroductionSarcopenia is linked to increased fall and hip fracture risk. However, studies often overlook comprehensively controlling for age, sex, bone mineral density (BMD), and body mass index (BMI). Our study aimed to determine if sarcopenia, determined by evaluating the psoas muscle volume, is an independent risk factor for hip fractures. We employed a methodological approach that includes the exact matching technique. MethodsIn this cross-sectional comparative study, we compared the data of patients who sustained hip fractures between 2015 and 2021 with those of a control group from a health screening center in a single center. The study included 545 patients with hip fractures and 1292 without fractures. We collected data on demographics, BMD determined using dual-energy X-ray absorptiometry, and abdominal and pelvic computed tomography (APCT) scans for psoas muscle volume analysis. ResultsThe analysis after exact matching of 266 pairs revealed that psoas volume/height2 was the most significant and dominant risk factor among the evaluated indices. Multivariate logistic regression analysis, adjusting for age, sex, BMI, and BMD, identified height or height2-adjusted psoas muscle volume as an independent risk factor for hip fractures (p = 0.042 and p = 0.002, respectively). Age, female sex, lower BMI, and lower BMD were associated with an increased risk of hip fractures. ConclusionDecreased psoas muscle volume adjusted for patient height independently predicts hip fracture risk. Psoas volume assessment via APCT is a practical tool for identifying at-risk individuals, emphasizing the necessity of including sarcopenia in hip fracture risk assessments.

Disparities in Dual-energy X-ray Absorptiometry Scan Utilization Across Race/Ethnic Groups Before and After Hip Fractures.

Geriatric hip fractures are common and important sentinel events regarding bone health. Although dual x-ray absorptiometry (DEXA) scans are a standard method for determining bone density, differences in use among various race/ethnic groups around the time of hip fracture may reveal disparities within the healthcare system. The 2014 to 2016 Medicare Standard Analytic Files PearlDiver data set was used to identify geriatric patients sustaining hip fracture. From that cohort, those who had a DEXA scan before or after their fracture were defined. For the defined cohorts, patient age, sex, Elixhauser Comorbidity Index, race/ethnicity, and income (based on zip code) were defined and compared with univariate and multivariate analyses. Of 58,099 hip fracture patients, only 19.8% had had a DEXA scan before fracture and 3.9% of the remaining group had the DEXA scan after fracture. Of the hip fracture population, 91.0% identified as White and 9.0% as non-White (Native American, Black, Hispanic, Asian, or Other). Before hip fracture, controlling for other variables and compared with White patients, all non-White categories were at lesser odds of having had the DEXA scan. After hip fracture, Black, Hispanic, and other patients were also at lesser odds of having the DEXA scan. Using a large Medicare data set, controlling for patient age, sex, Elixhauser Comorbidity Index, and income marker, this study revealed disparities in DEXA scan utilization across race/ethnic groups before and after presenting with a hip fragility fracture. Identification of such disparities highlights the needs for improved medical access and care for this at-risk hip fracture population.

Alcohol and drug use in adults younger than 60 years with hip fracture – A comparison of validated instruments and the clinical eye: A prospective multicenter cohort study of 218 patients

BackgroundIt is a common preconception that young individuals sustaining hip fractures have alcohol and/or drug use disorder. It is important to evaluate the actual use to avoid complications and plan the rehabilitation. AimThe primary objective was to assess alcohol and drug consumption in hip fracture patients <60 years using the validated Alcohol Use Disorders Identification Test (AUDIT) and Drug Use Disorders Identification Test (DUDIT) scores. We secondarily investigated the agreement between the instruments and the physicians’ clinical evaluation of usage. Material and methodsThis is a sub-study of 91 women and 127 men from a multicenter cohort study of patients with an acute hip fracture treated at four hospitals in Denmark and Sweden. AUDIT and DUDIT forms were completed by the patients. In addition, the researchers made an evaluation of the patients’ alcohol/drug use based on direct patient contact and information on previous alcohol/drug use from medical charts. AUDIT ranges 0–40 with 6 (women) and 8 (men) as the cut-off for hazardous use. DUDIT ranges 0–44 with cut-offs of 2 and 6 indicating drug-related problems. ResultsAccording to the AUDIT, 29 % of the patients had a hazardous alcohol use (25 % women, 31 % men), whilst the clinical evaluation identified 26 % (24 % women, 28 % men). However, there was a low agreement between “the clinical eye” and AUDIT, as the clinical evaluation only correctly identified 35 of 56 individuals with AUDIT-scores indicating hazardous alcohol use. DUDIT equaled drug related problems in 8 % (5 % women, 10 % men), the clinical evaluation depicted 8 % with drug related problems (4 % women, 10 % men). The agreement was low between “the clinical eye” and DUDIT; only 7 of 15 with DUDIT-scores indicating drug related problems were correctly identified. ConclusionHazardous alcohol consumption is more common in non-elderly hip fracture patients than in the general population. Considering both self-reported alcohol use and clinical evaluation, women have almost as high rate as men. DUDIT indicated drug related problems to be slightly more common than in the population. Still, a majority did not exhibit troublesome use of neither alcohol nor drugs. The two screening methods do not identify the same individuals, and further investigation in clinical practice is needed.

A Look Into How the "Blue Zone" Lifestyle May Affect Patients' Lives Before and After Hip Fracture: A Propensity-Matched Cohort Study.

Hip fractures are life-changing injuries with associated one-year mortality up to 30%. Five locations in the world have been termed "blue zones," where the longevity of the population is markedly higher than that of surrounding areas and there are 10 times more centenarians. The United States has one blue zone (Loma Linda, California), which is believed to be because of the lifestyle of the Seventh-day Adventist population living there. We hypothesized that patients from the blue zone experience low-energy, frailty-driven, osteoporotic hip fractures later in life and an increased postinjury longevity relative to non-blue zone control subjects. A review of patients treated for hip fracture between January 2010 and August 2020 from a single institution was conducted. Demographic data were collected, and the end point of mortality was assessed using death registry information, queried in April 2024. Groups were divided into blue zone and non-blue zone. Statistical analysis was conducted with P < 0.05 considered significant. Complete data were available for 1,032 patients. The blue zone cohort sustained low-energy hip fractures 12 years later in life (83.2 versus 71.1, P < 0.01). Propensity score matching was used to account for this difference. After propensity score matching, age, body mass index, American Society of Anesthesiologists score, surgery performed, sex, mechanism, ethnicity, diabetes, chronic obstructive pulmonary disease, CHF, chronic kidney disease grade, dementia, surgical time, and drug/tobacco/marijuana use were similar between groups. Blue zone patients had lower mortality at both 1 and 2 years postoperatively (12% versus 24%, P = 0.03 and 20% versus 33%, P = 0.03, respectively), had more hypertension (76% versus 62%, P = 0.03), reported lower alcohol use (7% versus 20%, P < 0.01), and included more Seventh-day Adventists (64% versus 15%, P < 0.01). The blue zone lifestyle affected the onset of frailty and delayed osteoporotic hip fracture by 12 years in this propensity-matched cohort study. Postoperative mortality was also markedly lower in the blue zone cohort.

Expedited surgery does not increase transfusion rates for patients with geriatric hip fracture taking factor Xa inhibitors.

Geriatric patients who sustain hip fractures and are taking factor Xa inhibitors (Xa-I) experience surgical delay. Our institution developed a pharmacokinetic protocol to formally guide and expedite surgical timing for these patients. The protocol is based on the patient's renal function and timing of last Xa-I dose. For patients with impaired renal function, longer wait times are recommended. The purpose of this study was to determine the effects of this protocol for patients with geriatric hip fracture taking Xa-I. Retrospective cohort study. Level 1 trauma center. A total of 164 patients aged 65 and older who were taking Xa-I before admission and underwent hip fracture surgery; 68 patients in the Standard group (2014-2018) and 96 patients in the Expedited group (2020-2022, after protocol implementation). Hip fracture surgery. Time to surgery (TTS), transfusion rate, blood loss, 90-day complication rates. The median TTS was significantly shorter in the Expedited group (28.6 hours, interquartile range 21.3 hours) than in the Standard group (44.8 hours, interquartile range 21.1 hours) (P < .001). There were no differences in overall transfusion rates. Multivariable regression analysis demonstrated that time to surgery was not predictive of transfusion rate in all patients (OR 1.00, 95% CI 0.99-1.02, P = .652). There were no differences in blood loss or rates of 90-day complications. Geriatric patients with hip fractures and taking factor Xa inhibitors may warrant earlier surgery without an increased risk of transfusion or bleeding. Therapeutic Level III.

THU430 Post Discharge Treatment Practice And Outcomes Following Osteoporotic Hip Fracture - A Tertiary Care Center Experience

Abstract Disclosure: N. Vaghasia: None. Y. Yin: None. F. Hasan: None. Introduction: Osteoporosis remains significantly undertreated. Even after osteoporotic hip fracture most patients remain untreated. Patients who sustain hip fracture have significant morbidity like subsequent fractures, loss of functional independence and high rate of readmission to hospital and also have high rate of mortality in subsequent years compared to controls. The objective of our study is to understand treatment practice and outcomes following hip fracture at a tertiary care hospital. Methods: We did a retrospective study of patients admitted between January 2016 and June 2020 with hip fracture at two tertiary care academic hospital. We included patient above 40 years of age who and previously not treated for osteoporosis. We excluded patients with traumatic fracture, advanced renal disease and active malignancy. We collected demographics like age, sex and race. Other variables like admitting and discharging team, length of hospital stay, readmission and mortality rate, referral to specialty (Endocrinology/Rheumatology) on discharge, specialty follow up after discharge, treatment initiation after discharge, preadmission and postadmission DXA scan and polypharmacy (five or more daily prescription medication) were collected. The primary objective of the study was to see the differences in treatment practice of osteoporosis fracture based on follow up with specialist versus primary care physician. Secondary objective was to see differences in outcomes like readmission and mortality based on treatment initiation and follow up with specialist. Results: Among the 421 patients reviewed, 253 met inclusion criteria. Among them 70.2% (177) were above 70 years age; 70.8% (179) were female; 94.4% (239) were Caucasian; 3.6% (9) were given referral to specialist on discharge; 8% (20) followed with specialist; 69.1% (170) were on polypharmacy; 64.3% (159) had readmission within two years and 23.6% (58) died within two years of hip fracture. Patients followed by specialist had higher chances of being treated with osteoporosis medication (70% vs. 6.9%, p&amp;lt;0.0001) and having post fracture DXA scan (84.2% vs. 13%, p&amp;lt;0.0001). Following specialist had higher chances of being treated within six months of fracture (40% vs. 4.3%, p&amp;lt;0.0001). Among those presented with hip fracture only 22.8% of female ≥ 65 years and 4.2% of male ≥ 70 years had preadmission DXA scan. Patients treated after hip fracture had lower rate of readmission (56.7% vs. 65.4%) and mortality (10% vs. 25.1%) however did not reach statistical significance due to small sample size of overall patients treated. Conclusion: Our study suggest that osteoporotic hip fracture remains significantly untreated. Follow up with specialist increases one’s chance of being treated especially early on after the fracture. Our study also suggest that screening guidelines of getting DXA scan in both female and male is significantly neglected. Presentation: Thursday, June 15, 2023

FRAX® Adjustment Using Renormalized Trabecular Bone Score (TBS) from L1 Alone may be Optimal for Fracture Prediction: The Manitoba BMD Registry

Lumbar spine trabecular bone score (TBS) used in conjunction with FRAX® improves 10-year fracture prediction. The derived FRAX risk adjustment is based upon TBS measured from L1-L4, designated TBSL1-L4-FRAX. In prior studies, TBS measurements that include L1 and exclude L4 give better fracture stratification than L1-L4. We compared risk stratification from TBS-adjusted FRAX using TBS derived from different combinations of upper lumbar vertebral levels renormalized for level-specific differences in individuals from the Manitoba Bone Density Program aged >40 years with baseline assessment of TBS and FRAX. TBS measurements for L1-L3, L1-L2 and L1 alone were calculated after renormalization for level-specific differences. Corresponding TBS-adjusted FRAX scores designated TBSL1-L3-FRAX, TBSL1-L2-FRAX and TBSL1-FRAX were compared with TBSL1-L4-FRAX for fracture risk stratification. Incident major osteoporotic fractures (MOF) and hip fractures were assessed. The primary outcome was incremental change in area under the curve (ΔAUC). The study population included 71,209 individuals (mean age 64 years, 89.8% female). Before renormalization, mean TBS for L1-3, L1-L2 and L1 was significantly lower and TBS-adjusted FRAX significantly higher than from using TBSL1-L4. These differences were largely eliminated when TBS was renormalized for level-specific differences. During mean follow-up of 8.7 years 6745 individuals sustained incident MOF and 2039 sustained incident hip fractures. Compared with TBSL1-L4-FRAX, use of FRAX without TBS was associated with lower stratification (ΔAUC = −0.009, p < 0.001). There was progressive improvement in MOF stratification using TBSL1-L3-FRAX (ΔAUC = +0.001, p < 0.001), TBSL1-L2-FRAX (ΔAUC = +0.004, p < 0.001) and TBSL1-FRAX (ΔAUC = +0.005, p < 0.001). TBSL1-FRAX was significantly better than all other combinations for MOF prediction (p < 0.001). Incremental improvement in AUC for hip fracture prediction showed a similar but smaller trend. In conclusion, this single large cohort study found that TBS-adjusted FRAX performance for fracture prediction was improved when limited to the upper lumbar vertebral levels and was best using L1 alone.

Excess mortality in elderly hip fracture patients: An Indian experience

PurposeHip fractures in elderly have a high mortality. However, there is limited literature on the excess mortality seen in hip fractures compared to the normal population. The purpose of this study was to compare the mortality of hip fractures with that of age and gender matched Indian population. MethodsThere are 283 patients with hip fractures aged above 50 years admitted at single centre prospectively enrolled in this study. Patients were followed up for 1 year and the follow-up record was available for 279 patients. Mortality was assessed during the follow-up from chart review and/or by telephonic interview. One-year mortality of Indian population was obtained from public databases. Standardized mortality ratio (SMR) (observed mortality divided by expected mortality) was calculated. Kaplan-Meir analysis was used. ResultsThe overall 1-year mortality was 19.0% (53/279). Mortality increased with age (p < 0.001) and the highest mortality was seen in those above 80 years (aged 50 – 59 years: 5.0%, aged 60 – 69 years: 19.7%, aged 70 – 79 years: 15.8%, and aged over 80 years: 33.3%). Expected mortality of Indian population of similar age and gender profile was 3.7%, giving a SMR of 5.5. SMR for different age quintiles were: 3.9 (aged 50 – 59 years), 6.6 (aged 60 – 69 years), 2.2 (aged 70 – 79 years); and 2.0 (aged over 80 years). SMR in males and females were 5.7 and 5.3, respectively. ConclusionsIndian patients sustaining hip fractures were about 5 times more likely to die than the general population. Although mortality rates increased with age, the highest excess mortality was seen in relatively younger patients. Hip fracture mortality was even higher than that of myocardial infarction, breast cancer, and cervical cancer.

Outcomes of Geriatric Hip Fractures in a Tertiary Referral Center in Malaysia During the COVID-19 Pandemic.

Introduction With the advancing age of the population, there are an increasing number of patients with geriatric hip fractures. Despite the advancement of surgical knowledge and improvement of implant designs to treat geriatric hip fractures, mortality and morbidity remainhigh among these frail patients. In conjunction with the COVID-19 pandemic, the collateral damage dealt to these patients remains unknown as scarce resources are funneled to deal with the pandemic. This study is geared to investigate the surgical outcomes of patients with geriatric hip fractures who were admitted during the initial phase of the COVID-19 pandemic. Methods This retrospective study was carried out at Hospital Kuala Lumpur, the largest public hospital in the capital of Malaysia, from March 1, 2020, to March 1, 2021. All patients of age 60 years and above were screened for suitability. Only patients who had undergone surgical intervention during the study period were included in this study. Patients' demographic data, mechanism of injury, waiting time for surgery, type of surgery, complications and ambulatory status were obtained from the medical records. Univariate analysis was performed to determine the factors associated with complications as well as the post-operative ambulatory status of the patients. Results A total of 52 patients were included in this study, with a median age of 72 years. The majority of the patients were Chinese (n=21, 40.4%). This was followed by Malay and Indian (n=14, 26.9% each) and other ethnicity (n=3, 5.8%). More than three-quarters of the patients had a trivial injury such as a fall due to a miss-step (n=16, 30.8%) and slip (n=16, 30.8%) and a fall due to dizziness (n=8, 15.4%). Only 12 patients (23.1%) sustained hip fractures due to trauma. The median time to surgery for these patients was 5 days (interquartile range: 4 days). Most of these patients underwent total hip replacement (n=30, 57.7%). This was followed by unipolar hemiarthroplasty (n=11, 21.2%), bipolar hemiarthroplasty (n=10, 19.2%) and internal fixation (n=1, 1.9%). Among these patients, six of them had documented complications. There were periprosthetic joint infection (n=2, 3.8%), dislocation (n=2, 3.8%), hematoma formation (n=1, 1.9%) and seroma (n=1, 1.9%). Six months after the surgery, most of the patients were able to ambulate, albeit some patients required walking aid such as walking stick and walking frame. Univariate analysis showed that all the factors were not associated with the complications and the post-operative ambulatory status of the patients. Conclusion The incidence of geriatric hip fractures remains high during the COVID-19 pandemic despite the movement control order (MCO) being enforced in Malaysia. With prompt surgical intervention, most of the patients can regain ambulatory status, albeit with a walking aid.

Reducing complications of femoral neck fracture management: a retrospective study on the application of multidisciplinary team

BackgroundFemoral neck fractures are associated with substantial morbidity and mortality for older adults. Multi-system medical diseases and complications can lead to long-term care needs, functional decline and death, so patients sustaining hip fractures usually have comorbid conditions that may benefit from application of multidisciplinary team(MDT).MethodsThis is a retrospective cohort study that incorporates medical record review with an outcomes management database. 199 patients were included who had surgery for a new unilateral femoral neck fracture from January 2018 to December 2021 (96 patients in usual care (UC) model and 103 patients in MDT model. High-energy, pathological, old and periprosthetic femoral neck fracture were excluded. Age, gender, comorbidity status, time to surgery, and postoperative complication, length of stay, in-hospital mortality, 30-day readmission rate, 90-day mortality data were collected and analyzed.ResultsPreoperative general data of sex, age, community dwelling and charlson comorbidity score of MDT group (n = 103) have no statistically significant difference with that of usual care (UC) group. Patients treated in the MDT model had significantly shorter times to surgery (38.5 vs. 73.4 h;P = 0.028) and lower lengths of stay (11.5 vs. 15.2 days;P = 0.031). There were no significant differences between two models in In-hospital mortality (1.0% vs. 2.1%; P = 0.273), 30-day readmission rate (7.8% vs. 11.5%; P = 0.352) and 90-day mortality (2.9% vs. 3.1%; P = 0.782). The MDT model had fewer complications overall (16.5% vs. 31.3%; P = 0.039), with significantly lower risks of delirium, postoperative infection, bleeding, cardiac complication, hypoxia, and thromboembolism.ConclusionApplication of MDT can provide standardized protocols and a total quality management approach, leading to fewer complications for elderly patients with femoral neck fracture.Trial registrationNo.

Influence of Risk Factors for Hip Injuries and Effect of Co-Morbidities on Postoperative Complications and Outcome after Hip Fracture Surgery in the Elderly

Background: Older adults who sustain hip fractures usually have multiple comorbidities that may impact their treatment and outcome. This study aims to analyze the risk factors that contribute to falls in elders and analyze the effect of comorbidities on the outcome and the treatment decision-making in elderly patients with hip fractures. Materials and Methods: This cohort study was conducted on patients with hip fractures. We prospectively analyzed 140 cases of geriatric hip fractures who had undergone surgery. The Charlson Comorbidity Index (CCI) and American Society of Anesthesiologists (ASA) of each geriatric hip fracture patient were calculated based on data retrieved from the medical records. Clinical assessment was assessed using a modified Harris hip score during each visit. Results: The mean age of patients was 72.21 ± 12.2 years. The mean CCI was 1.02 ± 0.3, and ASA was 2.0 ± 0.53, and both were significantly associated with time-to-surgery (P &lt; 0.001) and surgical treatment (P &lt; 0.001). The length of hospital stay, duration of postoperative intensive care, and hospital expenses were associated with both CCI (P = 0.037) and ASA (P = 0.002). Greater the CCI and ASA, more chances of developing postoperative complications (χ2 = 15.724, P = 0.001). Delirium is the most common postoperative complication 15.7%, and pulmonary infection 11.4% is the most lethal complication. Conclusions: Patients with high CCI, ASA grading, and revision surgery are at high risk of developing postoperative complications, morbidity, and mortality. With efficient medical co-management of these patients, orthogeriatric care offers the best chance for a successful outcome.

Mortality following hip fracture: Trends and geographical variations over the last SIXTY years

IntroductionThe management of hip fractures has advanced on all aspects from prevention pre-operatively, specialised hip fracture units, early operative intervention and rehabilitation. This is in line with the appropriate recognition over the past years of an important presentation with significant mortality and socioeconomic consequences of ever increasing incidence in an aging population. It is therefore imperative to continue to gather data on the incidence and trends of hip fractures to guide future management planning of this important presentation. MethodsA review of all articles published on the outcome after hip fracture over a twenty year period (1999-2018) was undertaken to determine any changes that had occurred in the demographics and mortality over this period. This article complements and expands upon the findings of a previous article by the authors assessing a four decade period (1959 – 1998) and attempts to present trends and geographical variations over sixty years. ResultsThe mean age of patients sustaining hip fractures continues to be steadily increasing at approximately just over 1 year of age for every 5-year time period. The mean age of patients sustaining hip fractures increased from 73 years (1960s) to 81 years (2000s) to 82 years (2010s). Over the six decade period one-year mortality has reduced from an overall mean of 27% (1960s) to 20% (2010s). The proportion of female hip fractures has decreased from 84% (1960s) to 70% (2010s). There is a decreasing trend in the proportion of intracapsular fractures from 54% (1970s) to 49% (2000s) and 48% (2010s). ConclusionOur study indicates that significant progress has been made with preventative planning, medical management, specialised orthogeriatric units and surgical urgency all playing a role in the improvements in mean age of hip fracture incidence and reduction in mortality rates. While geographical variations do still exist there has been an increase in the study of hip fractures globally with results now being published from more widespread institutions indicating appropriate increased attention and commitment to an ever-increasing presentation.

Mortality and Complications Following Early Conversion Arthroplasty for Failed Hip Fracture Surgery

BackgroundHip fracture in older patients leads to high morbidity and mortality. Patients who are treated surgically but fail acutely face a more complex operation with conversion total hip arthroplasty (THA). This study investigated mortalities and complications in patients who experienced failure within one year following hip fracture surgery requiring conversion THA. MethodsPatients aged 60 years or more undergoing conversion THA within one year following intertrochanteric or femoral neck fracture were identified and propensity-matched to patients sustaining hip fractures treated surgically but not requiring conversion within the first year. Patients who had two-year follow-up (91 conversions; 247 comparisons) were analyzed for 6-month, 12-month, and 24-month mortalities, 90-day readmissions, surgical complications, and medical complications. ResultsNonunion and screw cutout were the most common indications for conversion THA. Mortalities were similar between groups at 6 months (7.7% conversion versus 6.1% nonconversion, P = .774), 12 months (11% conversion versus 12% nonconversion, P = .999), and 24 months (14% conversion versus 22% nonconversion, P = .163). Survivorships were similar between groups for the entire cohort and by fracture type. Conversion THA had a higher rate of 90-day readmissions (14% versus 3.2%, P = .001), and medical complications (17% versus 6.1%, P = .006). Inpatient and 90-day orthopaedic complications were similar. ConclusionConversion THA for failed hip fracture surgery had comparable mortality rates to hip fracture surgery, with higher rates of perioperative medical complications and readmissions. Conversion THA following hip fracture represents a potential “second hit” that both surgeons and patients should be aware of with initial decision-making.

Influence of Risk Factors and Comorbidities on Postoperative Complications and Outcomes after Hip Fracture Surgery in the Elderly

Background: Older adults who sustain hip fractures usually have multiple comorbidities that may impact their treatment and outcome. This study was conducted with the aim to analyze the risk factors that contribute to falls in elderly individuals and analyze the effect of comorbidities on the outcome and the treatment in elderly patients with hip fractures.&#x0D; Methods: This cohort study was conducted on patients with hip fractures. We prospectively analyzed 140 individuals with geriatric hip fractures who had undergone surgery. The Charlson Comorbidity Index (CCI) and American Society of Anesthesiology (ASA) score of each geriatric hip fracture patient were calculated based on data obtained from medical records. Clinical assessment was assessed using a modified Harris Hip Score (HHS) during each visit.&#x0D; Results: The mean age of patients was 72.21 ± 12.2 years. Their mean CCI and ASA was 1.02 ± 0.3 and 2.0 ± 0.53, respectively, and both were significantly associated with time-to-surgery (P &lt; 0.001) and surgical treatment (P &lt; 0.001). The length of hospital stay, duration of postoperative intensive care, and hospital expenses were associated with both CCI (P = 0.037) and ASA (P = 0.002). The greater the CCI and ASA scores were, the higher the chances of developing postoperative complications were (X2 = 15.724; P = 0.001). Delirium was the most common postoperative complication (15.7%), and pulmonary infection (11.4%) was the most fatal complication.&#x0D; Conclusion: Patients with high CCI and ASA grading, and revision surgery were at high risk of postoperative complications, morbidity, and mortality. Orthogeriatric care offers the best chance for a successful outcome through efficient medical comanagement of these patients.

Elevated gamma-glutamyl transpeptidase level is associated with an increased risk of hip fracture in postmenopausal women

The aim of this study was to evaluate the association between gamma-glutamyl transferase (GGT) levels and the risk of hip fracture among middle-aged women by using the Korean National Health Insurance Service claims database from 2002 to 2015. After exclusion of those with any chronic liver disease, heavy alcohol consumption, any missing values required for our analysis, or GGT levels less than 1 or greater than 99 percentile, we classified subjects into three groups according to baseline GGT levels. A total of 127,141 women aged 50 years or older were included for analysis (GGT range: 8–106 U/L). During an average 12.1 years of follow-up, 2758 patients sustained hip fractures (2.17%). Compared with the group in the lowest tertile, the group in the highest tertile had the highest cumulative incidence of hip fracture. One log-unit increase in GGT was associated with a 17% increased risk of hip fracture. Subgroup analysis by BMI (≥ 25 vs. < 25 kg/m2), presence of diabetes, levels of other liver enzymes, and alcohol consumption level did not show significant effect modification. In summary, elevated baseline GGT level was associated with an increased risk of hip fracture in postmenopausal women, independent of alcohol consumption and chronic liver disease.

The Efficacy and Safety of Intravenous Iron in Geriatric Hip Fracture Surgeries: A Systematic Review and Meta‐Analysis

With the increasing evidence provided by recent high-quality studies, the intravenous iron appears to be a reliable therapy for blood administration in geriatric patients with hip fractures. Here, this systematic review and meta-analysis were aimed to assess the effectiveness and safety of intravenous iron in geriatric patients sustaining hip fractures. Potential pertinent literatures evaluating the effects of intravenous iron in the geriatric patients undergoing hip fractures were identified from Web of Science, PubMed, Embase, and Scopus. We performed a pairwise meta-analysis using fixed- and random-effects models, and the pooling of data was carried out by using RevMan 5.1. Four randomized controlled trials and four observational studies conform to inclusion criteria. The results of meta-analysis showed that intravenous iron reduced transfusion rates compared to the control group, yet the result did not reach statistical significance. The intravenous iron was related to lower transfusion volumes, shorter length of stay, and a reduced risk of nosocomial infections. And there was no significant difference in terms of the mortality and other complications between the treatment group and the control group. Current evidence suggests that intravenous iron reduces the transfusion volume, length of hospital stay, and risk of nosocomial infections. It takes about 7days for intravenous iron to elevate hemoglobin by 1g/dl and about 1month for 2g/dl. The safety profile of intravenous iron is also reassuring, and additional high-quality studies are needed.

The Impact of the Fascia Iliaca Block Beyond Perioperative Pain Control in Hip Fractures: A Retrospective Review.

BackgroundGeriatric hip fractures are common injuries that are associated with high morbidity and mortality. Adequate pain control remains a challenge as the altered physiology in elderly patients makes use of traditional analgesics challenging. The use of regional anesthetics, specifically the fascia iliaca compartment block (FICB), in the perioperative period has been shown to decrease opioid use in this population. This study aimed to investigate the effect the FICB had on pain control, length of stay, readmissions, and complications in a 30-day postoperative period.MethodsThis was a retrospective cohort study comparing patients who sustained hip fractures; one cohort (110 patients) received a preoperative fascia iliaca block with continuous infusion (FICB), whereas the other cohort (110 patients) did not receive a block (NO-FICB). Both cohorts were from level II trauma centers. Data were collected between 2016 and 2019. Descriptive statistics was performed to describe and summarize the data. Bivariate analysis was performed using chi-square test, with 2 tailed P-values ≤ .05 were considered statistically significant.ResultsThe FICB group had a lower length of stay (3.9 days vs 4.8 days; P < .001), and lower pain scores on post-operative days 2 and 3 (P = .019). There was no difference in time from admission to surgery (P = .112) or narcotic use between cohorts (P = .304). However, the FICB group was more likely to discharge to a skilled nursing facility (P=.002), and more likely to be readmitted within 30 days (P = .047). There were no differences in medical complications or mortality between the 2 groups.ConclusionsThe primary study endpoint, length of stay, was found to be significantly shorter in the patients who underwent the FICB vs the group who did not undergo the FICB. Pain scores on POD2 and POD3 were lower in patients who received a FICB. This study adds to the body of evidence that the FICB is an effective addition to a multimodal pain pathway.Level of EvidenceLevel III Evidence – Retrospective Cohort Study

974 ASSOCIATION BETWEEN NOTTINGHAM HIP FRACTURE SCORE AND FRAILTY IN ELDERLY ACUTE HIP FRACTURE PATIENTS

Abstract Introduction Nottingham Hip Fracture Score (NHFS) is a well validated risk stratification tool that has been shown to predict 30 day mortality in elderly patients with acute hip fractures. A lot of older patients that sustain hip fractures are frail. The Rockwood Clinical Frailty Scale (CFS) has been validated as a tool to screen for frailty in acutely ill patients and has been shown to predict outcomes in acutely ill elderly patients. The aim of this study was to determine if there is any correlation between the NHFS and CFS in elderly patients with acute hip fractures and to evaluate the effect of gender on this correlation. Method A retrospective, cross-sectional analysis was carried out on patients admitted with acute hip fractures between January and December 2019 in a single centre trauma and orthopaedic unit. Data was extracted from anonymized electronic patient records. Patients were included if they were 60 years and above; those less than 60 were excluded. Patients with missing data were excluded from analysis. NHFS and CFS were calculated in these patients. SPSS 27 IBM software was used for statistical analysis. Baseline characteristics were calculated using descriptive statistics and spearman’s correlation co-efficient and linear regression were used to determine correlation. Results A total of 268 patients were analysed—65 males and 202 females. Mean age was 83 years (SD 8.5). There was statistically significant positive correlation between NHFS and CFS in all patients, male patients and female patients (r = 0.589; p &amp;lt; 0.001, r = 0.603; p &amp;lt; 0.001, and r = 0.599; p &amp;lt; 0.001 respectively). Conclusion NHFS is positively correlated with CFS in elderly acute hip fracture patients. Reference(s) Doherty W.J, Stubbs T.A et al. Prediction of Postoperative Outcomes Following Hip Fracture Surgery: Independent Validation and Recalibration of the Nottingham Hip Fracture Score. Journal of the American Medical Directors Association;22(3):663–669.e2.

MO480: Predictive Ability of Clinical Assessment Tools For &amp;gt;2 Weeks in-Hospital Stay Following Hip Fracture in Patients Living With CKD: Insights From a 7-Year Prospective Analysis

Abstract BACKGROUND AND AIMS Individuals living with chronic kidney disease (CKD) are at greater risk of sustaining hip fractures compared with the general population. Following acute trauma, CKD patients are susceptible to lengthened hospitalization with their clinical condition exacerbated by frailty, co-morbidities and sarcopaenia. The most useful clinical assessment tools to predict lengthened in-hospital stays in patients with CKD following admission with hip fracture remain unestablished. METHOD Patients with CKD G3b-5 admitted from home to a tertiary centre hospital in North West UK with hip fracture between Jun 2013 and Jun 2020 were evaluated. Lengthened hospitalization is determined by &amp;gt;2 weeks of in-hospital stay in our analysis, given the average length of in-hospital stay is ∼14 days for the CKD population following hip fracture. Clinical assessment tools used in admission assessment for each patient included the Clinical Frailty Scale (CFS), Charlson's Co-morbidity Index (CCI), Chronic Kidney Disease Frailty Index Laboratory Score (CKD FI-LAB), Karnofsky's Performance Status Scale, Sernbo Score, Nottingham Hip Fracture Score, Estimated VO2 Peak, ASA Physical Status Classification System Score and the Abbreviated Mental Test Score. Receiver Operating Characteristic (ROC) curve analyses were performed to evaluate the ability of individual clinical assessment tools to predict for &amp;gt;2 weeks of in-hospital stay in patients with CKD admitted following hip fracture. RESULTS A total of 539 patients with CKDG3b-5 were admitted following hip fracture throughout the study period, of which 329 patients had &amp;gt;2 weeks of in-hospital stay. Within the cohort with &amp;gt;2 weeks of in-hospital stay, mean age was 84.4 ± 10.6 years. The female: male ratio was 1.6:1. Of those, 47 patients (14.3%) were on long-term dialysis. For this cohort, 30-day, 6-month and 1-year mortality were 6.7%, 14.9% and 43.2%, respectively. The odds ratio (OR) for 30-day {OR: 1.71, [95% confidence interval (95% CI) 1.04–2.39]; P &amp;lt; .01}, 6-month (OR: 2.06, 95% CI 1.38–2.73; P &amp;lt; .01) and 1-year mortality (OR: 2.62, 95% CI 1.95–3.30; P &amp;lt; .01) was significantly higher in CKD patients with &amp;gt; 2 weeks of in-hospital stay following hip fracture compared with those who were discharged within the first 2 weeks of hospitalization. Area Under the Curve (AUC) values from ROC analyses for individual clinical assessment tools are shown in Table 1. CONCLUSION Frailty and co-morbidity clinical assessment tools (CFS, CCI and CKD FI-LAB) displayed the best predictive ability for lengthened in-hospital stays in patients living with CKD admitted following hip fracture. CKD patients with lengthened in-hospital stays following hip fracture have greater risks of acute in-hospital mortality and mortality over the short- to medium-term following discharge. Research initiatives should continue to evaluate multidisciplinary management strategies for the older CKD population following acute trauma. Reducing the length of hospitalization may improve survival outcomes and alleviate costs and public health burdens in the care of the older CKD population.