Risk factors for urinary tract infection in geriatric hip fracture patients: a systematic review and meta-analysis
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PROVIDER: S-EPMC10884186 | biostudies-literature | 2024 Jan
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Project description:ObjectivesThis systematic review and meta-analysis was conducted to identify the potential risk factors for postoperative delirium in geriatric patients with hip fracture.MethodsPubMed, EMBASE, and Cochrane Library were searched from inception until December 31st, 2021. A combined searching strategy of subject words and free words was adopted. Studies involving risk factors for postoperative delirium in elderly patients undergoing hip fracture surgeries were reviewed. Qualities of included studies were assessed using the Newcastle-Ottawa Scale. Data were pooled and a meta-analysis was performed using Review Manager 5.3.ResultsA total of 37 studies were included. The following risk factors were significant: advanced age (per year increase) (OR: 1.05, 95% CI 1.04-1.07), age>80 years (OR: 2.26, 95% CI 1.47-3.47), male (OR: 1.53, 95% CI 1.37-1.70), preoperative cognitive impairment (OR:3.20, 95% CI 2.12-4.83), preoperative dementia (OR: 2.74, 95% CI 2.18-3.45), preoperative delirium (OR: 9.23, 95% CI 8.26-10.32), diabetes (OR: 1.18, 95% CI 1.05-1.33), preoperative functional dependence (OR: 1.31, 95% CI 1.11-1.56), ASA level (per level increase) (OR: 1.63, 95% CI 1.04-2.57), ASA level≥3(OR: 1.76, 95% CI 1.39-2.24), low albumin (OR: 3.30, 95% CI 1.44-7.55), medical comorbidities (OR: 1.15, 95% CI 1.06-1.25), Parkinson's disease (OR: 4.17, 95% CI 1.68-10.31) and surgery delay>48 h (OR: 1.90, 95% CI 1.36-2.65).ConclusionsClinicians should be alert to patients with those risk factors. To identify the risk factors more precisely, more research studies with larger sample size and better design should be conducted.
| S-EPMC9382199 | biostudies-literature
Project description:Postoperative pneumonia (POP) is a common postoperative complication. Negative consequences associated with POP included prolonged hospital length of stay, more frequent intensive care unit (ICU) stays, and a higher rate of sepsis, readmission, and mortality. This meta-analysis aimed to assess the incidence and risk factors associated with POP after hip fracture surgery in elderly patients. PubMed, Web of Science, and Cochrane Library were searched (up to March 31, 2022). All studies on the risk factors for POP after hip fracture surgery in elderly patients, published in English, were reviewed. The qualities of the included studies were assessed using the Newcastle-Ottawa Scale. Data were pooled, and a meta-analysis was performed. Ten studies, including 12,084 geriatric patients undergoing hip fracture surgery, were included. Of these 12,084 patients, POP occurred in 809 patients. The results indicated that age (mean difference [MD] = 4.95, 95% confidence interval [CI]: 3.22-6.69), male (odds ratio [OR] = 1.41, 95% CI: 1.02-1.93), the American Society of Anaesthesiologists classification ≥3 (OR = 3.48, 95% CI: 1.87-6.47), dependent functional status (OR = 5.23, 95% CI: 2.18-12.54, P = 0.0002), smoking (OR = 1.33, 95% CI: 1.07-1.65), chronic obstructive pulmonary disease (OR = 3.76, 95% CI: 2.07-6.81), diabetes mellitus (OR = 1.19, 95% CI: 1.01-1.40), coronary heart disease (OR = 1.74, 95% CI: 1.23-2.46), arrhythmia (OR = 1.47, 95% CI: 1.01-2.14), cerebrovascular disease (OR = 1.88, 95% CI: 1.56-2.27), dementia (OR = 2.36, 95% CI: 1.04-5.36), chronic renal failure (OR = 1.85, 95% CI: 1.29-2.67), hip arthroplasty (OR = 1.30, 95% CI: 1.08-1.56), delayed surgery (OR = 6.40, 95% CI: 3.00-13.68), preoperative creatinine (MD = 5.32, 95% CI: 0.55-10.08), and preoperative serum albumin (MD = -3.01, 95% CI: -4.21 - -1.80) were risk factors for POP. Related prophylactic measures should be provided in geriatric patients with the above-mentioned risk factors to prevent POP after hip fracture surgery.
| S-EPMC9837248 | biostudies-literature
Project description:ContextThe incidence of urinary tract infection (UTI) varies with age, but there is limited evidence on the role of other risk factors.ObjectiveThe aim of this meta-analysis was to investigate the risk factors for UTIs in children.Data sourcesPubMed from 1966 to May 2019.Study selectionAll studies assessing at least 1 possible risk factor for occurrence or recurrence of UTI with a clear definition of symptomatic UTI in children were eligible. We excluded studies with UTIs related to hospital treatment or severe congenital renal abnormalities.Data extractionAfter the quality assessment we extracted data on the given risk factor in children with and without UTI. The data were extracted separately for the occurrence and recurrence of UTIs.ResultsWe included 24 studies in the meta-analysis. Circumcision decreased the occurrence of UTIs with an odds ratio (OR) of 0.1 [95% confidence interval (CI): 0.06-0.17) and breast-feeding with an OR of 0.4 (CI: 0.19-0.86), both with low heterogeneity. Being overweight or obese increased the risk of UTI (OR: 2.23; CI: 1.37-3.63). Both poor fluid intake (OR: 6.39; CI: 3.07-13.39) and infrequent voiding (OR: 3.54; CI: 1.68-7.46) were associated with recurrent UTIs.LimitationsThe design, populations and definitions varied between the studies.ConclusionsBeing overweight or obese and having poor fluid intake are modifiable risk factors that increase the risk for UTIs in children. Breast-feeding and circumcision are associated with a decreased occurrence of UTIs.
| S-EPMC9508987 | biostudies-literature
Project description:BackgroundHip fracture is a devastating health-care problem in a geriatric patient, leading to high mortality and morbidity. Preoperative risk assessment in the geriatric patient is often inexact because of the difficulty in measuring their poor physiologic reserves.AimsThe primary objective was to find the association of modified frailty index (MFI) with 90-day mortality in geriatric patients who received anesthesia for fractured hip. Secondary objectives were to assess the association of preoperative waiting time with the 90-day mortality and the correlation of preexisting medical conditions with poor functional outcome among the survivors.Settings and designsThis prospective, observational study was conducted at a tertiary care institution.Subjects and methodsIn this prospective observational study, done over a period of 1 year, 60 geriatric patients aged ≥65 years who received anesthesia for fractured hip and fulfilled selection criteria were recruited. The association of MFI with 90-day mortality and the correlation of preexisting comorbidities with poor functional outcome among the survivors were assessed.Statistical analysis usedIndependent sample t-test, Mann-Whitney test, and odds ratio were used as applicable.ResultsTotal 60 patients were available for analysis as two patients dropped off from final 62 on follow up, fifty three patients survived after 90 days. MFI and 90-day mortality showed a significant direct correlation with P < 0.0001. However, no association was found between the preoperative waiting time and 90-day mortality. Preexisting medical conditions showed a significant association of dementia with total dependence afterward with a P = 0.02.ConclusionThere is significant statistical correlation of MFI with the 90-day mortality in the geriatric hip-fractured patients undergoing surgery.
| S-EPMC6020579 | biostudies-literature
Project description:BackgroundIncontinence and hip fractures are common in older people, especially women, and associated with multiple adverse effects. Incontinence is a risk factor for falls.AimsWe aimed to investigate the prevalence of urinary (UI) and double incontinence (DI, concurrent UI and faecal incontinence), and to identify factors associated with UI and DI 6 months post-fracture.MethodsA prospective real-life cohort study was conducted consisting of 910 women aged ≥ 65 who were treated for their first hip fracture in Seinäjoki Central Hospital, Finland, between May 2008 and April 2018. Continence status was elicited at baseline and 6 months postoperatively at our geriatric outpatient clinic where all participants underwent a multidisciplinary comprehensive geriatric assessment (CGA) consisting of an evaluation of cognition, nutrition, mood, mobility, and functional ability.ResultsAt baseline, 47% of the patients were continent, 45% had UI and 8% had DI, and at follow up, 38%, 52%, and 11%, respectively. The mean age of the patients was 82.7 ± 6.8. Both UI and DI were associated with functional disability and other factors related to frailty. The associations were particularly prominent for patients with DI who also had the worst performance in the domains of CGA. We identified several modifiable risk factors: depressive mood (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.16-2.84) and constipation (OR 1.48, 95% CI 1.02-2.13) associated with UI and, late removal of urinary catheter (OR 2.33, 95% CI 1.31-4.14), impaired mobility (OR 2.08, 95% CI 1.05-4.15), and poor nutrition (OR 2.31, 95% CI 1.11-4.79) associated with DI.ConclusionsThis study demonstrates a high prevalence of UI and DI in older women with hip fracture and modifiable risk factors, which should be targeted in orthogeriatric management and secondary falls prevention. Patients with DI were found to be an especially vulnerable group.
| S-EPMC9151507 | biostudies-literature
Project description:BackgroundDisplaced femoral neck fractures in geriatric patients are typically treated with either hemiarthroplasty or total hip arthroplasty. The choice between hemiarthroplasty and total hip arthroplasty requires a good estimate of the patient's life expectancy, as the recent HEALTH trial suggests that the benefits of the two operations do not diverge, if at all, until the second year post-operatively. A systematic review was this performed to determine if there sufficient information in the medical literature to estimate a patient's life expectancy beyond two years and to identify those patient variables affecting survival of that duration.MethodsPubmed, Embase, and Cochrane databases were queried for articles reporting survival data for at least two years post-operatively for at least 100 patients, age 65 or greater, treated surgically for an isolated hip fracture. A final set of 43 papers was created. The methods section of all selected papers was then reviewed to determine which variables were collected in the studies and the results section was reviewed to note whether an effect was reported for all collected variables.ResultsThere were 43 eligible studies with 25 unique variables identified. Only age, gender, comorbidities, the presence of dementia and fracture type were collected in a majority of studies, and within that, only age and gender were reported in a majority of the results. Most (15/ 25) variables were reported in 5 or fewer of the studies.DiscussionThere are important deficiencies in the literature precluding the evidence-based estimation of 2 year life expectancy. Because the ostensible advantages of total hip arthroplasty are reaped only by those who survive two years or more, there is a need for additional data collection, analysis and reporting regarding survival after geriatric hip fracture.
| S-EPMC8673659 | biostudies-literature
Project description:ObjectiveThis study aimed to systematically assess the incidence and risk factors for hospital-acquired pneumonia (HAP) in hip fracture patients by meta-analysis.MethodsSystematically searched four English databases (PubMed, EMBASE, The Cochrane Library, and Web Of Science) and four Chinese databases (CNKI, CQVIP, Sinomed, and WAN FANG) from inception until 20 November 2023. All studies involving risk factors of HAP in patients with hip fractures were considered. Newcastle-Ottawa Scale was used to evaluate the quality of the included studies. The results were presented with the pooled odds ratio (OR) and 95% confidence interval (95% CI).ResultsOf 35 articles (337,818 patients) included in this study, the incidence of HAP was 89 per 1000 cases. Twenty-three risk factors were eventually involved in the meta-analysis, and 21 risk factors were significant. Our study has identified four significant risk factors (advanced age, preoperative time, COPD, and hypoalbuminemia) associated with HAP, as follows: Advanced age as a continuous variable (OR 1.07, 95% CI 1.05-1.10), Advanced age > 70 years (OR 2.34, 95% CI 1.77-3.09), Advanced age > 80 years (OR 2.98, 95% CI 2.06-4.31), Chronic obstructive pulmonary disease (COPD) (OR 3.44, 95% CI 2.83-4.19), Time from injury to operation as a continuous variable (OR 1.09, 95% CI 1.07-1.12), Time from injury to operation ≥48 h (OR 3.59, 95% CI 2.88-4.48), Hypoalbuminemia < 3.0 g/dL (OR 3.03, 95% CI 1.93-4.73), and Hypoalbuminemia < 3.5 g/dL (OR 2.68, 95% CI 2.15-3.36). However, it is important to note that all the studies included in our research were retrospective in nature, which introduces certain limitations to the level of evidence and the ability to establish causal inferences.DiscussionPatients who have suffered hip fractures are at an increased risk of developing postoperative hospital-acquired pneumonia, which can lead to prolonged hospital stays and adverse clinical outcomes. Consequently, the identification of these risk factors offers novel insights and methodologies for healthcare professionals in terms of both prevention and treatment.Trial registrationRegistration number: INPLASY2022100091.
| S-EPMC10759764 | biostudies-literature
Project description:ObjectivesTo identify risk factors for recurrent urinary tract infection (UTI) and renal scarring in children who have had 1 or 2 febrile or symptomatic UTIs and received no antimicrobial prophylaxis.MethodsThis 2-year, multisite prospective cohort study included 305 children aged 2 to 71 months with vesicoureteral reflux (VUR) receiving placebo in the RIVUR (Randomized Intervention for Vesicoureteral Reflux) study and 195 children with no VUR observed in the CUTIE (Careful Urinary Tract Infection Evaluation) study. Primary exposure was presence of VUR; secondary exposures included bladder and bowel dysfunction (BBD), age, and race. Outcomes were recurrent febrile or symptomatic urinary tract infection (F/SUTI) and renal scarring.ResultsChildren with VUR had higher 2-year rates of recurrent F/SUTI (Kaplan-Meier estimate 25.4% compared with 17.3% for VUR and no VUR, respectively). Other factors associated with recurrent F/SUTI included presence of BBD at baseline (adjusted hazard ratio: 2.07 [95% confidence interval (CI): 1.09-3.93]) and presence of renal scarring on the baseline (99m)Tc-labeled dimercaptosuccinic acid scan (adjusted hazard ratio: 2.88 [95% CI: 1.22-6.80]). Children with BBD and any degree of VUR had the highest risk of recurrent F/SUTI (56%). At the end of the 2-year follow-up period, 8 (5.6%) children in the no VUR group and 24 (10.2%) in the VUR group had renal scars, but the difference was not statistically significant (adjusted odds ratio: 2.05 [95% CI: 0.86-4.87]).ConclusionsVUR and BBD are risk factors for recurrent UTI, especially when they appear in combination. Strategies for preventing recurrent UTI include antimicrobial prophylaxis and treatment of BBD.
| S-EPMC4485012 | biostudies-literature
Project description:Hospital readmissions following severe infections are a major economic burden on the health care system and have a negative influence on patients' quality of life. Understanding the risk factors for readmission, particularly the extent to which they could be prevented, is of a great importance. In this study we evaluated potentially preventable risk factors for 60-day readmission in patients surviving hospitalization for complicated urinary tract infection (cUTI). This was a multinational, multicentre retrospective cohort study conducted in Europe and the Middle East. Our cohort included survivors of hospitalization due to cUTI during the years 2013-2014. The primary outcome was 60-day readmission following index hospitalization. Patient characteristics that could have influenced readmission: demographics, infection presentation and management, microbiological and clinical data; were collected via computerized medical records from infection onset up to 60 days after hospital discharge. Overall, 742 patients were included. The cohort median age was 68 years (interquartile range, (IQR) 55-80) and 43.3% (321/742) of patients were males. The all-cause 60-day readmission rate was 20.1% (149/742) and more than half were readmitted for infection [57.1%, (80/140)]. Recurrent cUTI was the most frequent cause for readmission [46.4% (65/140)]. Statistically significant risk factors associated with 60-day readmission in multivariable analysis were: older age (odds ratio (OR) 1.02 for an one-year increment, confidence interval (CI) 1.005-1.03), diabetes mellitus (OR 1.63, 95% CI 1.04-2.55), cancer (OR 1.7, 95% CI 1.05-2.77), previous urinary tract infection (UTI) in the last year (OR 1.8, 95% CI: 1.14-2.83), insertion of an indwelling bladder catheter (OR 1.62, 95% CI 1.07-2.45) and insertion of percutaneous nephrostomy (OR 3.68, 95% CI 1.67-8.13). In conclusion, patients surviving hospitalization for cUTI are frequently re-hospitalized, mostly for recurrent urinary infections associated with a medical condition that necessitated urinary interventions. Interventions to avoid re-admissions should target these patients.
| S-EPMC7994309 | biostudies-literature
Project description:IntroductionType 2 diabetes mellitus (T2DM) is a frequent chronic condition among the elderly, which increasing their susceptibility to infection. Urinary tract infection (UTI) is one of the most prevalent infections among older people with T2DM. However, the association between geriatric T2DM and the risk of UTI has not been thoroughly researched and is still contentious. Consequently, this protocol describes a systematic review to pinpoint the primary risk factors for UTI among elderly T2DM. Our goal is to improve recommendations for the creation of targeted treatment interventions by examining risk factors for UTI in elderly individuals with T2DM.Methods and analysisWe will search 4 English literature databases (PubMed, Embase, Web of Science, and Cochrane Library) and 3 major Chinese databases (CNKI, WanFang, and VIP) from the establishment of the database to June 20, 2024. Systematic evaluation and meta-analysis will be conducted on cohort and case-control studies exploring the occurrence and risk determinants of UTI in individuals diagnosed with T2DM. The main focus will be on identifying the risk factors for UTI in elderly diabetic patients. Two researchers will independently review articles, collect data, and evaluate the quality and potential bias of study inclusion. We will use RevMan V.5.4 software to analyze the data. The quality of the included studies will be assessed using the Newcastle-Ottawa scale. In addition, the GRADE (Grade of Recommendations, Assessment, Development, Evaluation) method will be used to examine the quality of evidence for each exposure and outcome of interest.DiscussionThis study aims to illuminate the various risk factors associated with UTI in older patients diagnosed with T2DM. By this thorough investigation, we hope to provide a more comprehensive reference for medical professionals and researchers, thereby supporting the implementation of effective preventive strategies against UTI and improving overall nursing outcomes for this specific patient population.Trail registrationPROSPERO (CRD42024559129).
| S-EPMC11426445 | biostudies-literature