[Risk factors affecting mortality in patients with hip fractures at a regional trauma center].
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ABSTRACT: Background
Primary care hospitals and regional trauma centers play an essential role in the treatment of hip fractures.Objective
This study investigated the relationship between patient-related parameters and in-hospital mortality as well as complications of hip fractures at a regional trauma center.Methods
In a retrospective study, data were collected from all patients > 60 years admitted over 2 years to a regional trauma center with a hip fracture. Patient-related parameters included age, sex, fracture location, method of surgical treatment, time of surgery, duration of surgery, length of inpatient stay, blood transfusion, complications, comorbidities, use of anticoagulant medication and need for postoperative intensive care treatment. The relationship between these parameters and hospital mortality as well as complications was investigated.Results
Data were collected from 360 patients undergoing 335 surgeries (f:m 225:110) with a mean age of 83 ± 8 years. The total in-hospital mortality rate was 7.76% (n = 26). Factors increasing in-hospital mortality included: age > 85 years (odds ratio [OR] 5.126; 95% confidence interval [CI] 0.665-39.498; p = 0.1167); male sex (OR 1.85 95%-CI [0.82-4.14]; p = 0.0555); time of surgery > 24 h (OR 1.896 95%-CI [0.661-5.441]; p = 0.2341); ≥ 3 comorbidities (OR 10.61 95%-CI [3.681-27.501]; p < 0.0001); intake of anticoagulants (OR 6.19 95%-CI [2.69-14.24]; p < 0.0001) and postoperative intensive care (OR 5.9 95%-CI [2.56-13.76]; p < 0.0001).Conclusion
In the present study a statistically significant influence of the number of comorbidities or Charlson comorbidity index, the intake of anticoagulant drugs and need for postoperative intensive care treatment on the in-hospital mortality of patients with proximal femoral fractures in a regional trauma center was found.
SUBMITTER: Darwich A
PROVIDER: S-EPMC8458164 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PurposeTrauma-related injuries are the leading cause of death worldwide. Some risk factors make traumatic patients susceptible to infection. Furthermore, some mortality risk factors, including length of hospitalization and increasing age, were detected in non-traumatic infected patients. This study aimed to assess mortality risk factors among nosocomial infected traumatic patients in Rajaee trauma center, Shiraz, Iran.MethodsThis prospective cohort study was conducted during a period of 2 years since April 2015 to March 2017 in Rajaee hospital, which is the center of emergency medical services for traumatic injuries in Shiraz, Iran. Centers for Disease Control and Prevention/National Healthcare Safety Network surveillance system criteria were applied to define 5 types of nosocomial infections. The variables analyzed as the risk factors of infection and mortality included sex, age, mechanism of injury, site of injury, injury severity score (ISS), surgical intervention, length of hospitalization, intensive care unit (ICU) admission, and type of pathogen. Then, the incidence of nosocomial infection and also risk factors of mortality in traumatic patients were evaluated. All data analyses were performed using the statistical package for social sciences, version 15 (SPSS Inc., Chicago) and p ≤ 0.05 is considered to be statistically significant.ResultsThe incidence of nosocomial infection was 7.2% (p < 0.001). Pneumonia was the most common type of infection detected in our study. Infection led to a 7.8-fold increase in mortality of the traumatic patients (p < 0.001). Admission in intensive care units and old age were the main risk factors of mortality in infected traumatic patients. Old age, gunshot and motor vehicle accidents, trauma to extremities and abdomen, higher injury severity score, and prolonged hospitalization, made the traumatic patients more susceptible to infection.ConclusionThe really high incidence of nosocomial infection in traumatic patients in Iran depends on some risk factors that should be considered. Also infection increases the mortality rate in the traumatic patients, which could be reduced by eliminating its risk factors.
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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.
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Project description:BackgroundThere are multiple reports on the effect of time to surgery for geriatric hip fractures; it remains unclear if earlier intervention is associated with improved mortality, hospital length of stay (HLOS), or cost.MethodsThis was a multi-center retrospective cohort study. Patients (≥65y.) admitted (1/14-1/16) to six level 1 trauma centers for isolated hip fractures were included. Patients were dichotomized into early (≤24 h of admission) or delayed surgery (>24 h). The primary outcome was mortality using the CDC National Death Index. Secondary outcomes included HLOS, complications, and hospital cost.ResultsThere were 1346 patients, 467 (35%) delayed and 879 (65%) early. The early group had more females (70% vs. 61%, p < 0.001) than the delayed group. The delayed group had a median of 2 comorbidities, whereas the early group had 1, p < 0.001. Mortality and complications were not significantly different between groups. After adjustment, the delayed group had no statistically significant increased risk of dying within one year, OR: 1.1 (95% CI:0.8, 1.5), compared to the early group. The average difference in HLOS was 1.1 days longer for the delayed group, when compared to the early group, p-diff<0.001, after adjustment. The average difference in cost for the delayed group was $2450 ($1550, $3400) more expensive per patient, than the early group, p < 0.001.ConclusionsThe results of this study provide further evidence that surgery within 24 h of admission is not associated with lower odds of death when compared to surgery after 24 h of admission, even after adjustment. However, a significant decrease in cost and HLOS was observed for early surgery. If causally linked, our data are 95% confident that earlier treatment could have saved a maximum of $1,587,800. Early surgery should not be pursued purely for the motivation of reducing hospital costs.Level of evidenceLevel III.
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Project description:Background: Malnutrition is frequently underdiagnosed in geriatric patients and is considered to be a contributing factor for worse outcomes during hospitalization. In addition, elderly patients who undergo trauma are often malnourished at the time of incurring fractures. The geriatric nutritional risk index (GNRI), calculated based on the serum albumin level and the ratio of present body weight to ideal body weight, was proposed for the assessment of the nutritional status of elderly patients with various illnesses. This study aimed to investigate whether the GNRI has a prognostic value that links the nutritional status and mortality outcomes of elderly patients who have previously undergone trauma with femoral fractures.Methods: From January 1, 2009 to December 31, 2019, a total of 678 elderly patients with femoral fractures were categorized into four nutritional risk groups: a major-risk group (GNRI <82; group 1, n = 127), moderate-risk group (GNRI 82- <92; group 2, n = 179), low-risk group (GNRI 92-98; group 3, n = 123), and no-risk group (GNRI >98; group 4, n = 249). To minimize the confounding effects of sex, age, preexisting comorbidities, and injury severity of patients on outcome measurements, propensity score-matched patient cohorts were created to assess the impact of patients being in different nutritional risk groups on the in-hospital mortality outcomes against the no-risk group.Results: The patients in groups 1-3 were significantly older and presented a significantly lower body mass index and lower serum albumin levels than those in group 4. Compared with patients in group 4 (3.6%), a significantly higher mortality rate was found in the patients in group 1 (17.3%, p < 0.001), but not in those in group 2 (6.7%) or group 3 (2.4%). The study of propensity score-matched patient cohorts provided similar results; group 1 patients had significantly higher odds of mortality than group 4 patients (odds ratio, 6.3; 95% confidence interval, 1.34-29.37; p = 0.009), but there were no significant differences in mortality risks among patients in groups 2 and 3 compared with those in group 4.Conclusions: This preliminary study suggested that the GNRI may be used as a screening tool to identify patients with malnutrition at a high risk of mortality among elderly patients with femoral fractures. A prospective study is needed to validate the suggestion.
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