Primary hemiarthroplasty after unstable trochanteric fracture in elderly patients: mortality, readmission and reoperation

Abstract Background Most unstable trochanteric fractures are treated with internal fixation and often with high complication rates. Hemiarthroplasty might be an alternative method in difficult condition, especially in unstable comminuted fracture in fragile bone. However, few have investigated the long-term outcomes after hemiarthroplasty for unstable trochanteric fracture. We conducted a population-based retrospective cohort study of trochanteric fracture after primary hemiarthroplasty using competing risk analysis on their long-term outcomes, including mortality, readmission and reoperation. Methods We studied a total of 2798 patients over 60 years old, with a mean age of 79 years, of which 68% are females and 67.23% have at least one comorbidity. They underwent a hemiarthroplasty for unstable trochanteric fracture during the period between January 1, 2000 and December 31, 2010 and were follow-up until the end of 2012, or death. Survival analysis and Cox model were used to characterize mortality. Competing risk analysis and Fine and Gray model were used to estimate the cumulative incidences of the first readmission and the first reoperation. Results The follow-up mortality rate for 1-year was 17.94%; 2-year, 29.76%; 5-year, 56.8%; and 10-year, 83.38%. The cumulative incidence of the first readmission was 16.4% for 1-year and 22.44% for 3-year. The cumulative incidence of the first reoperation was 13.87% for 1-year, 18.11% for 2-year, 25.79% for 5-year, and 38.24% for 10-year. Male gender, older age, higher Charlson Comorbidity Index (CCI) and lower insured amount were all risk factors for the overall mortality. Older age and higher CCI were risk factors for the first readmission. Older age was a protective factor for reoperation, which is likely due to the competing death. Conclusions The mortality and revision rates after hemiarthroplasty for unstable trochanteric fracture are acceptable as a salvage procedure for this fragile sub-population.

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Fresh Unstable Trochanteric Fracture in Elderly Patients: Mortality, Readmission and Reoperation After Primary Hemiarthroplasty

10.21203/rs.3.rs-199113/v1 ◽

2021 ◽

Author(s):

Tzu-Chieh Lin ◽

Pin-Wen Wang ◽

Chun-Teng Lin ◽

Yu-Jun Chang ◽

Ying-Ju Lin ◽

...

Keyword(s):

Risk Factors ◽

Alternative Treatment ◽

Cumulative Incidence ◽

Protective Factor ◽

Trochanteric Fracture ◽

Older Age ◽

Complication Rates ◽

Long Term Outcomes ◽

Early Weight Bearing

Abstract Objectives: Most unstable trochanteric fractures are treated with internal fixation often with high complication rates. Hemiarthroplasty is an alternative treatment to achieve early weight-bearing, early mobilization and acceptable functional outcomes. However, few have investigated the long-term outcomes after hemiarthroplasty for unstable trochanteric fracture. We investigated patients with fresh trochanteric fracture after primary hemiarthroplasty on their long-term outcomes, including mortality, readmission and reoperation.Methods: We studied a total of 2,798 elderly adults who had received hemiarthroplasty for fresh unstable trochanteric fracture from 2000 to 2010, and followed them up until the end of 2012. Survival analysis and Cox model were used to characterize mortality. Competing risk analysis and Fine and Gray model were used to estimate the cumulative incidences of the first readmission and the first reoperation.Results: The follow-up mortality rate for 1-year was 17.94%; 2-year, 29.76%; 5-year, 56.8%; and 10-year, 83.38%. The cumulative incidence of the first readmission was 16.4% for 1-year and 22.44% for 3-year. The cumulative incidence of the first reoperation was 13.87% for 1-year, 18.11% for 2-year, 25.79% for 5-year, and 38.24% for 10-year. Male, older age, larger CCI and lower insured amount were all risk factors for the overall mortality. Older age and larger CCI were risk factors for the first readmission. Older age was a protective factor for reoperation, which is likely due to the competing death.Conclusion: Results are consistent with hemiarthroplasty being a robust alternative treatment for unstable trochanteric fracture among a heterogeneous elderly population.

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633 Mortality risk factors in European prostate cancer patients treated with radical prostatectomy. Competing risk analysis with 15-years follow up

European Urology Supplements ◽

10.1016/s1569-9056(15)60626-1 ◽

2015 ◽

Vol 14 (2) ◽

pp. e633-e633b

Author(s):

K. Böhm ◽

B. Beyer ◽

P. Karakiewicz ◽

H. Huland

Keyword(s):

Prostate Cancer ◽

Risk Factors ◽

Radical Prostatectomy ◽

Risk Analysis ◽

Cancer Patients ◽

Mortality Risk ◽

Competing Risk ◽

Competing Risk Analysis

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Risk Factors of Mortality from All Asbestos-Related Diseases: A Competing Risk Analysis

Canadian Respiratory Journal ◽

10.1155/2017/9015914 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Rafael Abós-Herràndiz ◽

Teresa Rodriguez-Blanco ◽

Isabel Garcia-Allas ◽

Isabel-Magdalena Rosell-Murphy ◽

Constança Albertí-Casas ◽

...

Keyword(s):

Risk Factors ◽

Risk Analysis ◽

Incidence Rate ◽

Hazard Analysis ◽

Competing Risk ◽

Competing Risk Analysis ◽

Subdistribution Hazard ◽

Related Disease ◽

Asbestos Related Disease

Background. The mortality from all malignant and nonmalignant asbestos-related diseases remains unknown. The authors assessed the incidence and risk factors for all asbestos-related deaths. Methods. The sample included 544 patients from an asbestos-exposed community in the area of Barcelona (Spain), between Jan 1, 1970, and Dec 31, 2006. Competing risk regression through a subdistribution hazard analysis was used to estimate risk factors for the outcomes. Results. Asbestos-related deaths were observed in 167 (30.7%) patients and 57.5% of these deaths were caused by some type of mesothelioma. The incidence rate after diagnosis was 3,600 per 100,000 person-years. In 7.5% of patients death was non-asbestos-related, while pleural and peritoneal mesothelioma were identified in 87 (16.0%) and 18 (3.3%) patients, respectively. Conclusions. Age, sex, household exposure, cumulative nonmalignant asbestos-related disease, and single malignant pathology were identified as risk factors for asbestos-related death. These findings suggest the need to develop a preventive approach to the community and to improve the clinical follow-up process of these patients.

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PD30-06 MORTALITY RISK FACTORS IN EUROPEAN PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY. COMPETING RISK ANALYSIS WITH 15-YEARS FOLLOW UP

The Journal of Urology ◽

10.1016/j.juro.2015.02.1827 ◽

2015 ◽

Vol 193 (4S) ◽

Author(s):

Katharina Boehm ◽

Burkhard Beyer ◽

Alessandro Larcher ◽

Jonas Schiffmann ◽

Pierre Karakiewicz ◽

...

Keyword(s):

Prostate Cancer ◽

Risk Factors ◽

Radical Prostatectomy ◽

Risk Analysis ◽

Cancer Patients ◽

Mortality Risk ◽

Competing Risk ◽

Competing Risk Analysis

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Decreasing Postoperative Pulmonary Complication Following Laparoscopic Surgery in Elderly Individuals with Colorectal Cancer: A Competing Risk Analysis in a Propensity Score–Weighted Cohort Study

Cancers ◽

10.3390/cancers14010131 ◽

2021 ◽

Vol 14 (1) ◽

pp. 131

Author(s):

Yih-Jong Chern ◽

Jeng-Fu You ◽

Ching-Chung Cheng ◽

Jing-Rong Jhuang ◽

Chien-Yuh Yeh ◽

...

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Risk Analysis ◽

Elderly Patients ◽

Open Surgery ◽

Competing Risk ◽

Competing Risk Analysis ◽

Long Term Outcomes ◽

Laparoscopy Group

Advanced age is a risk factor for major abdominal surgery due to a decline in physical function and increased comorbidities. Although laparoscopic surgery provides good results in most patients with colorectal cancer (CRC), its effect on elderly patients remains unclear. This study aimed to compare the short- and long-term outcomes between open and laparoscopic surgeries in elderly patients with CRC. Total 1350 patients aged ≥75 years who underwent curative resection for stage I–III primary CRC were enrolled retrospectively and were divided into open surgery (846 patients) and laparoscopy (504 patients) groups. After propensity score weighting to balance an uneven distribution, a competing risk analysis was used to analyze the short-term and long-term outcomes. Postoperative mortality rates were lower in the laparoscopy group, especially due to pulmonary complications. Postoperative hospital stay was significantly shorter in the laparoscopy group than in the open surgery group. Overall survival, disease-free survival, and competing risk analysis showed no significant differences between the two groups. Laparoscopic surgery for elderly patients with CRC significantly decreased pulmonary-related postoperative morbidity and mortality in this large cohort study. Laparoscopic surgery is a favorable method for elderly patients with CRC than open surgery in terms of less hospital stay and similar oncological outcomes.

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Cumulative incidence and risk factors for radiation induced leukoencephalopathy in high grade glioma long term survivors

Scientific Reports ◽

10.1038/s41598-021-89216-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Robert Terziev ◽

Dimitri Psimaras ◽

Yannick Marie ◽

Loic Feuvret ◽

Giulia Berzero ◽

...

Keyword(s):

Risk Factors ◽

Cumulative Incidence ◽

High Grade Glioma ◽

High Grade ◽

Nucleotide Polymorphisms ◽

Increased Risk ◽

Radiation Induced ◽

Long Term Survivors

AbstractThe incidence and risk factors associated with radiation-induced leukoencephalopathy (RIL) in long-term survivors of high-grade glioma (HGG) are still poorly investigated. We performed a retrospective research in our institutional database for patients with supratentorial HGG treated with focal radiotherapy, having a progression-free overall survival > 30 months and available germline DNA. We reviewed MRI scans for signs of leukoencephalopathy on T2/FLAIR sequences, and medical records for information on cerebrovascular risk factors and neurological symptoms. We investigated a panel of candidate single nucleotide polymorphisms (SNPs) to assess genetic risk. Eighty-one HGG patients (18 grade IV and 63 grade III, 50M/31F) were included in the study. The median age at the time of radiotherapy was 48 years old (range 18–69). The median follow-up after the completion of radiotherapy was 79 months. A total of 44 patients (44/81, 54.3%) developed RIL during follow-up. Twenty-nine of the 44 patients developed consistent symptoms such as subcortical dementia (n = 28), gait disturbances (n = 12), and urinary incontinence (n = 9). The cumulative incidence of RIL was 21% at 12 months, 42% at 36 months, and 48% at 60 months. Age > 60 years, smoking, and the germline SNP rs2120825 (PPARg locus) were associated with an increased risk of RIL. Our study identified potential risk factors for the development of RIL (age, smoking, and the germline SNP rs2120825) and established the rationale for testing PPARg agonists in the prevention and management of late-delayed radiation-induced neurotoxicity.

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Abstract 555: The Universal Clinical Classification of Acute Myocardial Infarction is a Better Predictor of Long Term Outcomes than ST Segment Classification

Circulation ◽

10.1161/circ.118.suppl_18.s_579-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Manuel A Gonzalez ◽

Dana Eilen ◽

Rana A Marzouq ◽

Saed Awadallah ◽

Hiren R Patel ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Inverse Relationship ◽

Long Term Outcomes ◽

St Segment ◽

Vascular Beds

Introduction: The universal classification (UC) of AMI aims to facilitate cross-study analysis, yet the long-term outcomes using UC are largely unknown. Hypothesis: We tested the hypothesis that the long-term outcome of patients with AMI is better predicted by UC than ST segment classification. Methods: We conducted a prospective study of 348 consecutive patients with AMI with mean follow-up of 30.6 months. The primary outcome was the major adverse cardiovascular events (MACE) [composite of all causes of mortality, recurrent AMI, and stroke]. Multivariate and survival analysis of MACE was performed. Results: The study population was STEMI=168, NSTEMI=180, Type 1=278, Type 2=55, Type 3=5, Type 4a=2, Type 4b=5, and Type 5=3. During follow-up 80 patients died, 31 had an AMI, and 7 had a stroke. UC correlates with the ST segment classification (p<0.005). MACE free survival was different for Type 1 and Type 2 (p=0.043), but not for STEMI and NSTEMI. There was a positive association between MACE and the quartile of peak Troponin, number of cardiovascular risk factors, and number of vascular beds affected, and an inverse relationship with the utilization of discharge cardiovascular protective medications (all p≤0.01). No such inverse relationship existed for Type 2. Conclusions: UC of AMI is a better long-term predictor of MACE. The quartile of peak Troponin levels, cardiovascular risk factors, and number of vascular beds affected are independent predictors of MACE, while cardiac medications protect against MACE, except in Type 2 patients.

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Predictors of ICU admission and long-term outcomes in overdose presentations to Emergency Department

Australasian Psychiatry ◽

10.1177/1039856219889317 ◽

2020 ◽

Vol 28 (1) ◽

pp. 75-79

Author(s):

Mark Savage ◽

Ross Kung ◽

Cameron Green ◽

Brandon Thia ◽

Dinushka Perera ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Emergency Department ◽

Psychiatric Illness ◽

Atypical Antipsychotics ◽

Long Term Outcomes ◽

Icu Admission ◽

History Of

Objective: To describe the characteristics of patients presenting to an Emergency Department (ED) following overdoses; to identify risk factors for intensive care unit (ICU) admission among these patients; and to identify the rate of mortality and repeat overdose presentations over four years. Methods: Adult patients presenting to ED following drug overdose during 2014 were included. Data were collected from medical notes and hospital databases. Results: During the study period, 654 patients presented to ED 800 times following overdose. Seventy-eight (9.8%) resulted in ICU admission, and 59 (7.4%) required intubation; 57.2% had no history of overdose presentations, and 72.9% involved patients with known psychiatric illness. Overdose of atypical antipsychotics (AAP), age and history of prior overdose independently predicted ICU admission. A third of patients ( n = 196, 30%) had subsequent presentations to ED following overdose, in the four years from their index presentation, with an all-cause four-year mortality of 3.4% ( n = 22). Conclusion: A history of overdose, use of AAP and older age were risk factors for ICU admission following ED presentations. Over a third of patients had repeat overdose presentation in the four-year follow-up with a mortality of 3.4%.

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