scholarly journals A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery

2021 ◽  
Author(s):  
Rebecka Ahl ◽  
Ahmad Mohammad Ismail ◽  
Tomas Borg ◽  
Gabriel Sjölin ◽  
Maximilian Peter Forssten ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Beta Blocker ◽  
Observational Cohort Study ◽  
Blocker Therapy ◽  
Beta Blocker Therapy ◽  
Hip Fracture Surgery ◽  
All Cause Mortality ◽  
Observational Cohort ◽  
Fracture Surgery

Abstract Purpose Despite advances in the care of hip fractures, this area of surgery is associated with high postoperative mortality. Downregulating circulating catecholamines, released as a response to traumatic injury and surgical trauma, is believed to reduce the risk of death in noncardiac surgical patients. This effect has not been studied in hip fractures. This study aims to assess whether survival benefits are gained by reducing the effects of the hyper-adrenergic state with beta-blocker therapy in patients undergoing emergency hip fracture surgery. Methods This is a retrospective nationwide observational cohort study. All adults $$\ge$$ ≥ 18 years were identified from the prospectively collected national quality register for hip fractures in Sweden during a 10-year period. Pathological fractures were excluded. The cohort was subdivided into beta-blocker users and non-users. Poisson regression with robust standard errors and adjustments for confounders was used to evaluate 30-day mortality. Results 134,915 patients were included of whom 38.9% had ongoing beta-blocker therapy at the time of surgery. Beta-blocker users were significantly older and less fit for surgery. Crude 30-day all-cause mortality was significantly increased in non-users (10.0% versus 3.7%, p < 0.001). Beta-blocker therapy resulted in a 72% relative risk reduction in 30-day all-cause mortality (incidence rate ratio 0.28, 95% CI 0.26–0.29, p < 0.001) and was independently associated with a reduction in deaths of cardiovascular, respiratory, and cerebrovascular origin and deaths due to sepsis or multiorgan failure. Conclusions Beta-blockers are associated with significant survival benefits when undergoing emergency hip fracture surgery. Outlined results strongly encourage an interventional design to validate the observed relationship.

scholarly journals Beta-Blocker Therapy Is Associated With Increased 1-Year Survival After Hip Fracture Surgery: A Retrospective Cohort Study

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ahmad Mohammad Ismail ◽  
Rebecka Ahl ◽  
Maximilian Peter Forssten ◽  
Yang Cao ◽  
Per Wretenberg ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Beta Blocker ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Blocker Therapy ◽  
Beta Blocker Therapy ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

scholarly journals β-Adrenergic blockade in patients with dementia and hip fracture is associated with decreased postoperative mortality

2021 ◽  
Author(s):  
Ioannis Ioannidis ◽  
Ahmad Mohammad Ismail ◽  
Maximilian Peter Forssten ◽  
Yang Cao ◽  
Gary Alan Bass ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Beta Blocker ◽  
Postoperative Mortality ◽  
Adrenergic Blockade ◽  
Blocker Therapy ◽  
Beta Blocker Therapy ◽  
Hip Fracture Surgery ◽  
Diagnosis Of Dementia ◽  
Relevant Variables ◽  
Fracture Surgery

Abstract Purpose Dementia, present in 20% of hip fracture patients, is associated with an almost threefold increase in postoperative mortality risk. These patients have a substantially higher incidence of cardiovascular, respiratory, and cerebrovascular mortality after hip fracture surgery compared to patients without dementia. This study aimed to investigate the association between beta-blocker therapy and postoperative mortality in patients with dementia undergoing hip fracture surgery. Methods This nationwide study included all patients in Sweden with the diagnosis of dementia who underwent emergency surgery for a hip fracture between January 2008 and December 2017. Cases where the hip fracture was pathological or conservatively managed were not included. Poisson regression analysis with robust standard errors was performed while controlling for confounders to determine the relationship between beta-blocker therapy and all-cause, as well as cause-specific, postoperative mortality. Results A total of 26,549 patients met the study inclusion criteria, of whom 8258 (31%) had ongoing beta-blocker therapy at time of admission. After adjusting for clinically relevant variables, the incidence of postoperative mortality in patients receiving beta-blocker therapy was decreased by 50% at 30 days [adj. IRR (95% CI) 0.50 (0.45–0.54), p < 0.001] and 34% at 90 days [adj. IRR (95% CI) 0.66 (0.62–0.70), p < 0.001]. Cause-specific mortality analysis demonstrated a significant reduction in the incidence of postoperative cardiovascular, respiratory, and cerebrovascular death within 30 and 90 days postoperatively. Conclusion Beta-blocker therapy is associated with decreased postoperative mortality in hip fracture patients with dementia up to 90 days after surgery. This finding warrants further investigation.

scholarly journals Red Blood Cell Transfusion and Postoperative Delirium in Hip Fracture Surgery Patients: A Retrospective Observational Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Jacob Raphael ◽  
Nadia B. Hensley ◽  
Jonathan Chow ◽  
K. Gage Parr ◽  
John S. McNeil ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Postoperative Delirium ◽  
Observational Cohort Study ◽  
Hip Fracture Surgery ◽  
Observational Cohort ◽  
Fracture Surgery ◽  
Rbc Transfusion

Background. Patients having hip fracture surgery are at high risk for postoperative delirium. Red blood cell (RBC) transfusion may increase postoperative delirium risk by causing neuroinflammation. We hypothesized that RBC transfusion would be associated with postoperative delirium in patients having hip fracture surgery. Methods. An observational cohort study was performed using the United States National Surgical Quality Improvement Program (NSQIP) participant use files for hip fracture from 2016 to 2018. Propensity score analysis and inverse probability of treatment weighting (IPTW) were used to reduce bias from confounding. An IPTW adjusted odds ratio for developing postoperative delirium was calculated for patients who received RBC transfusion during surgery or in the 72 hours after. Results. There were 20,838 patients who had eligible current procedural terminology (CPT) codes for primary hip fracture surgery and complete study data. After employing strict exclusions to balance covariates and reduce bias, 3,715 patients remained in the IPTW cohort. Of these, 626 patients (16.9%) received RBC transfusion and 665 patients (17.9%) developed postoperative delirium. IPTW adjustment led to good covariate balance between patients who received RBC transfusion and those who did not. Patients who received RBC transfusion had significantly higher odds of postoperative delirium, IPTW adjusted odds ratio = 1.21, 95% CI = 1.03 to 1.43, and P  = 0.02. Discharge location also differed significantly between patients who received RBC transfusion and those who did not ( P  < 0.001) with in-hospital mortality or referral to hospice occurring in 1.6% of patients who received RBC transfusion and 1.3% of patients who were not transfused. Conclusion. RBC transfusion is associated with increased odds of postoperative delirium after hip fracture surgery and may be associated with worse clinical outcome.

scholarly journals Effects of hospital funding reform on wait times for hip fracture surgery: a population-based interrupted time-series analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Pincus ◽  
Jessica Widdifield ◽  
Karen S. Palmer ◽  
J. Michael Paterson ◽  
Alvin Li ◽  
...  
Keyword(s):  
Time Series ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Wait Times ◽  
Hospital Funding ◽  
Hip Fracture Surgery ◽  
After Hours ◽  
Fracture Surgery

Abstract Background Health care funding reforms are being used worldwide to improve system performance but may invoke unintended consequences. We assessed the effects of introducing a targeted hospital funding model, based on fixed price and volume, for hip fractures. We hypothesized the policy change was associated with reduction in wait times for hip fracture surgery, increase in wait times for non-hip fracture surgery, and increase in the incidence of after-hours hip fracture surgery. Methods This was a population-based, interrupted time series analysis of 49,097 surgeries for hip fractures, 10,474 for ankle fractures, 1,594 for tibial plateau fractures, and 40,898 for appendectomy at all hospitals in Ontario, Canada between April 2012 and March 2017. We used segmented regression analysis of interrupted monthly time series data to evaluate the impact of funding reform enacted April 1, 2014 on wait time for hip fracture repair (from hospital presentation to surgery) and after-hours provision of surgery (occurring between 1700 and 0700 h). To assess potential adverse consequences of the reform, we also evaluated two control procedures, ankle and tibial plateau fracture surgery. Appendectomy served as a non-orthopedic tracer for assessment of secular trends. Results The difference (95 % confidence interval) between the actual mean wait time and the predicted rate had the policy change not occurred was − 0.46 h (-3.94 h, 3.03 h) for hip fractures, 1.46 h (-3.58 h, 6.50 h) for ankle fractures, -3.22 h (-39.39 h, 32.95 h) for tibial plateau fractures, and 0.33 h (-0.57 h, 1.24 h) for appendectomy (Figure 1; Table 3). The difference (95 % confidence interval) between the actual and predicted percentage of surgeries performed after-hours − 0.90 % (-3.91 %, 2.11 %) for hip fractures, -3.54 % (-11.25 %, 4.16 %) for ankle fractures, 7.09 % (-7.97 %, 22.14 %) for tibial plateau fractures, and 1.07 % (-2.45 %, 4.59 %) for appendectomy. Conclusions We found no significant effects of a targeted hospital funding model based on fixed price and volume on wait times or the provision of after-hours surgery. Other approaches for improving hip fracture wait times may be worth pursuing instead of funding reform.

scholarly journals Depressive Disorders Lead to Increased Complications After Geriatric Hip Fractures

2021 ◽  
Vol 12 ◽  
pp. 215145932110162
Author(s):  
Matthew S. Broggi ◽  
Philip O. Oladeji ◽  
Syed Tahmid ◽  
Roberto Hernandez-Irizarry ◽  
Jerad Allen
Keyword(s):  
Risk Factor ◽  
Hip Fracture ◽  
Postoperative Complications ◽  
Hip Fractures ◽  
Depressive Disorders ◽  
Surgical Site Infections ◽  
Wound Complications ◽  
Non Union ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Introduction: Intertrochanteric hip fractures are a common injury treated by orthopedic surgeons and the incidence rate is rising. Preoperative depression is a known risk factor for postoperative complications in orthopaedic surgery, however its effects on outcomes after geriatric hip fractures is relatively unknown. The purpose of this study was to investigate the relationship between preoperative depression and potential complications following open reduction internal fixation (ORIF) and intramedullary nailing (IMN) of geriatric hip fractures. Methods: In this retrospective study, the Truven Marketscan claims database was used to identify patients over age 65 who underwent ORIF or IMN for a hip fracture from January 2009 to December 2019. Patient characteristics, such as medical comorbidities, were collected and from that 2 cohorts were established (one with and one without depression). Chi-squared and multivariate analysis was performed to investigate the association between preoperative depression and common postoperative complications following intertrochanteric hip fracture surgery. Results: In total, 78,435 patients were identified for analysis. In those patients with preoperative depression, the complications associated with the greatest increased odds after undergoing ORIF were surgical site infections (OR 1.32; CI 1.23-1.44), ED visit for pain (OR 1.27; CI 1.16-1.39), wound complications (OR 1.26; CI 1.14-1.35), and non-union (OR 1.25; CI 1.17-1.33). In the patients with preoperative depression undergoing IMN, the complications associated with the greatest increased odds after were surgical site infections (OR 1.37; CI 1.31- 1.45), ED visit for pain (OR 1.31; CI 1.19-1.44), wound complications (OR 1.23; CI 1.10-1.39), and pneumonia (OR 1.22; CI 1.10-1.31). Conclusions: Preoperative depression in patients undergoing hip fracture surgery is associated with increased complications. Recognizing a patients’ preoperative depression diagnosis can allow physicians to adapt perioperative and postoperative surveillance protocols for these higher risk patients. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor

scholarly journals Re-Admissions Following Hip Fracture Surgery

2009 ◽  
Vol 91 (7) ◽  
pp. 591-595 ◽  
Author(s):  
James Hahnel ◽  
Hannah Burdekin ◽  
Sanjeev Anand
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
The Elderly ◽  
Index Admission ◽  
Study Cohort ◽  
Rehabilitation Care ◽  
Hip Fracture Surgery ◽  
Fatal Adverse Events ◽  
The Uk ◽  
Fracture Surgery

INTRODUCTION Hip fractures in the elderly are a growing problem with a predicted incidence of 117,000 cases per year by 2016. Re-admission following a healthcare episode is an important outcome measure, which reflects non-fatal adverse events and indicates the natural history of disease. The purpose of this observational, multicentre audit was to examine rates and reasons for re-admission following hip fracture, to identify areas in the index admission and rehabilitation care that could be improved to prevent re-admission. PATIENTS AND METHODS A total of 535 patients (> 65 years old) in two district general hospitals in the UK who underwent hip fracture surgery were recruited into the study. RESULTS Of the study cohort, 72 patients (13.5%) died during their index admission and 88 (19.0%) of 463 patients were re-admitted once within 3 months. Causes of re-admission were attributed to medical (54.8%), failure to rehabilitate (23.8%), orthopaedic (19.0%) and surgical (2.4%) reasons. Infection was the most common (31.0%) reason for re-admission and arguably the most treatable. During the 3-month postoperative period, the mortality rate was 21.3%, increasing in those re-admitted to 35.1% representing the frailty of this group of patients. CONCLUSIONS High rates of re-admission are seen following discharge in elderly patients with hip fractures. Re-admitted patients have high mortality rates. Understanding causes of re-admission may help to reduce this burden.

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