Health economics for intra-capsular hip fractures undertaking fixation

BACKGROUND Hip fracture is a common musculoskeletal injury in the elderly requiring surgery worldwide.The operative mainstay of intra-capsular hip fractures is arthroplasty with a smaller proportion for fixation.AIM To determine the most beneficial method of fixation for patients with intracapsular hip fractures.METHODS A registered audit from 2012-2018 was conducted on all intra-capsular hip fractures treated with 2 commonly used fixation methods.Patient notes,electronic records and clinical codes for cost benefit were evaluated.A validated quality of life measure was collected at least 1 year after surgery.RESULTS A total of 83 patients were identified with intra-capsular fractures undergoing fixation during the retrospective period.There were 47 cannulated cancellous screw and 36 sliding hip screw fixations with the case mix comparable for age,gender,co-morbidities and fracture configuration.There was no significant difference in blood loss,tip apex distance,radiation exposure,length of stay,radiological union time,collapse,avascular necrosis or re-operation between fixation methods.Logistic regression analysis demonstrated displaced intracapsular hip fractures correlated significantly with an undesirable outcome conferring a relative odds ratio of 7.25.There were 9(19%)and 4(11%)patients respectively,who required re-operation.There was no significant difference in health resource group tariff and implant cost with comparable EQ-5D and visual CONCLUSION No significant advantage was identified with differing fixation type,but irrespective there were a high number of patients requiring re-operation.This was predicted by initial fracture displacement and patient age.Arthroplasty may need to be carefully considered for health economics and patient benefit.

Evaluation of Some Treatment Options Inlate and Neglected Hip Fractures Using the Modified Harris Hip Score

Background: The choice of the appropriate operative intervention in patients with late and neglected hip fracture continuous to be a huge dilemma for orthopedic surgeons. Purpose: To evaluate the satisfaction or otherwise of some treatment options using the modified Harris-hip score (HHS) in resource poor setting. Materials and Methods: A retrospective cross-sectional study conducted at ATBUTH, Bauchi. Data of 60 patients over the age of 18 years with hip fractures (femoral neck, intertrochanteric and sub trochanteric fractures) who had operative intervention between 1st September 2019 and 31st August 2020 with cannulated screws, Proximal femur lock compression plate (PFLCP), cementlessor cemented bipolar hemiarthroplasty (BHA). Results: The mean age of studied patients was 65.7 ± 16.1 years, with age ranging from 19 - 101 years. M:F ratio was 1.2:1 across all age groups and 1:1.4 amongst those >60 years. 51 patients (85%) presented > 1 week after injury with 24 patients (40%) sustaining hip fractures from low energy trivial indoor fall and 28 patients (46.7%) mostly younger sustaining fractures from high energy motor vehicular accident (MVA). The prevalence rate for femoral neck, intertrochanteric and subtrochanteric fractures were 32 (53.3%), 17 (28.3%) and 11 (18.3%) respectively. From the data retrieved, 21patients (35.0%), 17 patients (28.3%), 20 patients (33.3%) and 2 patients (3.3%) had PFLCP, cemented BHA, cementless BHA and cannulated screw fixation respectively. Most (66.7%) of those who had PFLCP achieved satisfactory radiologic union and there was also 94.1% and 85% satisfactory outcome rate amongst the patients with cemented BHA and cementless BHA respectively. Irrespective of the operative intervention method at 1 year follow-up, there was a statistically significant improvement in post-operative HHS (P value 0.02), with 83.4% having good to excellent results. Conclusion: There is highrate of late and neglected hip fracture in our environment. Satisfactory outcome with statistically significant improvement in Post-operative HHS was achieved in patients treated for hip fractures.

Two surgical pathways for isolated hip fractures:A comparative study

BACKGROUND Hip fractures(HF)are common among the aging population,and surgery within 48 h is recommended.Patients can be hospitalized for surgery through different pathways,either trauma or medicine admitting services.AIM To compare management and outcomes among patients admitted through the trauma pathway(TP)vs medical pathway(MP).METHODS This Institutional Review Board-approved retrospective study included 2094 patients with proximal femur fractures(AO/Orthopedic Trauma Association Type 31)who underwent surgery at a level 1 trauma center between 2016-2021.There were 69 patients admitted through the TP and 2025 admitted through the MP.To ensure comparability between groups,66 of the 2025 MP patients were propensity matched to 66 TP patients by age,sex,HF type,HF surgery,and American Society of Anesthesiology score.The statistical analyses included multivariable analysis,group characteristics,and bivariate correlation comparisons with theχ^(2)test and t-test.RESULTS After propensity matching,the mean age in both groups was 75-years-old,62%of both groups were females,the main HF type was intertrochanteric(TP 52%vs MP 62%),open reduction internal fixation was the most common surgery(TP 68%vs MP 71%),and the mean American Society of Anesthesiology score was 2.8 for TP and 2.7 for MP.The majority of patients in TP and MP(71%vs 74%)were geriatric(≥65-years-old).Falls were the main mechanism of injury in both groups(77%vs 97%,P=0.001).There were no significant differences in pre-surgery anticoagulation use(49%vs 41%),admission day of the week,or insurance status.The incidence of comorbidities was equal(94%for both)with cardiac comorbidities being dominant in both groups(71%vs 73%).The number of preoperative consultations was similar for TP and MP,with the most common consultation being cardiology in both(44%and 36%).HF displacement occurred more among TP patients(76%vs 39%,P=0.000).Time to surgery was not statistically different(23 h in both),but length of surgery was significantly longer for TP(59 min vs 41 min,P=0.000).Intensive care unit and hospital length of stay were not statistically different(5 d vs 8 d and 6 d for both).There were no statistical differences in discharge disposition and mortality(3%vs 0%).CONCLUSION There were no differences in outcomes of surgeries between admission through TP vs MP.The focus should be on the patient’s health condition and on prompt surgical intervention.

Effects of surgical treatment modalities on postoperative cognitive function and delirium in elderly patients with extremely unstable hip fractures

BACKGROUND As the perioperative risk of elderly patients with extremely unstable hip fractures(EUHFs)is relatively high and therapeutic effect is not satisfactory,new therapeutic strategies need to be proposed urgently to improve the efficacy and clinical outcomes of such patients.AIM To determine the influence of two surgical treatment modalities on postoperative cognitive function(CF)and delirium in elderly patients with EUHFs.METHODS A total of 60 elderly patients consecutively diagnosed with EUHF between September 2020 and January 2022 in the Chongqing University Three Gorges Hospital were included.Of them,30 patients received conventional treatment(control group;general consultation+fracture type-guided internal fixation),and the other 30 received novel treatment(research group;perioperative multidisciplinary treatment diagnosis and treatment+individualized surgical plan+risk prediction).Information on hip function[Harris hip score(HHS)],perioperative risk of orthopedic surgery[Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity(POSSUM)],CF[Montreal cognitive assessment scale(MoCA)],postoperative delirium[mini-cognitive(Mini-Cog)],adverse events(AEs;internal fixation failure,infection,nonunion,malunion,and postoperative delirium),and clinical indicators[operation time(OT),postoperative hospital length of stay(HLOS),ambulation time,and intraoperative blood loss(IBL)]were collected from both groups for comparative analyses.RESULTS The HHS scores were similar between both groups.The POSSUM score at 6 mo after surgery was significantly lower in the research group compared with the control group,and MoCA and Mini-Cog scores were statistically higher.In addition,the overall postoperative complication rate was significantly lower in the research than in the control group,including reduced OT,postoperative HLOS,ambulation time,and IBL.CONCLUSION The new treatment modality has more clinical advantages over the conventional treatment,such as less IBL,faster functional recovery,more effectively optimized perioperative quality control,improved postoperative CF,mitigated postoperative delirium,and reduced operation-related AEs.

Predictability of Surgical Apgar Score for postoperative outcomes in hip fractures: A prospective observational study

Objective:To assess the utility and validation of the Surgical Apgar Score(SAS)in predicting postoperative complications of hip fractures.Methods:This prospective observational study included patients who received operations for hip fractures from 1st March 2017 to 30th June 2018 at the Department of Orthopedic Surgery,Liaquat National Hospital and Medical College.Patients were followed at the outpatient department,and complications and mortality were recorded through phone calls.The predictability of SAS for postoperative complications was assessed.Results:SAS≤4 was found as a significant predictor for postoperative pulmonary(P=0.008)and cardiac complications(P=0.042)as well as blood transfusion required to optimize postoperative hemoglobin(P=0.03)in the patients with hip fractures.Conclusions:SAS provides reliable feedback information about patients'postoperative risk during the surgery.Hip fracture patients with scores≤4 should be monitored for major complications both during the hospital admission and after the discharge.

Clinical analysis of nosocomial infection in 180 elderly patients with hip fractures

Objective To discuss the hip fracture in elderly patients with nosocomial infection,to take effective prevention and control measures. Methods Retrospective analysis of data of the elderly hip fracture combined with nosocomial infection during 2009 - 2010 was performed. Results A total of 180 cases of femoral neck

Trabecular Plate Loss and Deteriorating Elastic Modulus of Femoral Trabecular Bone in Intertrochanteric Hip Fractures

Osteoporotic hip fracture is associated with significant trabecular bone loss, which is typically characterized as low bone density by dual-energy X-ray absorptiometry （DXA） and altered microstructure by micro-computed tomography （pCT）. Emerging morphological analysis techniques, e.g. individual trabecula segmentation （ITS）, can provide additional insights into changes in plate-like and rod-like trabeculae, two major micro- structural types serving different roles in determining bone strength. Using ITS, we evaluated trabecular microstructure of intertrochanteric bone cores obtained from 23 patients undergoing hip replacement surgery for intertrochanteric fracture and 22 cadaveric controls. Micro-finite element （~FE） analyses were performed to further understand how the abnormalities seen by ITS might translate into effects on bone strength. ITS analyses revealed that, near fracture site, plate-like trabeculae were seriously depleted in fracture patients, but trabecular rod volume was maintained. Besides, decreased plate area and rod length were observed in fracture patients. Fracture patients also showed decreased elastic moduli and shear moduli of trabecular bone. These results provided evidence that in intertrochanteric hip fracture, preferential loss of plate-like trabeculae led to more rod-like microstructure and deteriorated mechanical competence adjacent to the fracture site, which increased our understanding of the biomechanical pathogenesis of hip fracture in osteoporosis.

Effect of weekend admission on geriatric hip fractures

BACKGROUND The care discrepancy for patients presenting to a hospital on the weekend relative to the work week is well documented.With respect to hip fractures,however,there is no consensus about the presence of a so-called“weekend effect”.This study sought to determine the effects,if any,of weekend admission on care of geriatric hip fractures admitted to a large tertiary care hospital.It was hypothesized that geriatric hip fracture patients admitted on a weekend would have longer times to medical optimization and surgery and increased complication and mortality rates relative to those admitted on a weekday.AIM To determine if weekend admission of geriatric hip fractures is associated with poor outcome measures and surgical delay.METHODS A retrospective chart review of operative geriatric hip fractures treated from 2015-2017 at a large tertiary care hospital was conducted.Two cohorts were compared:patients who arrived at the emergency department on a weekend,and those that arrived at the emergency department on a weekday.Primary outcome measures included mortality rate,complication rate,transfusion rate,and length of stay.Secondary outcome measures included time from emergency department arrival to surgery,time from emergency department arrival to medical optimization,and time from medical optimization to surgery.RESULTS There were no statistically significant differences in length of stay(P=0.2734),transfusion rate(P=0.9325),or mortality rate(P=0.3460)between the weekend and weekday cohorts.Complication rate was higher in patients who presented on a weekend compared to patients who presented on a weekday(13.3%vs 8.3%;P=0.044).Time from emergency department arrival to medical optimization(22.7 h vs 20.0 h;P=0.0015),time from medical optimization to surgery(13.9 h vs 10.8 h;P=0.0172),and time from emergency department arrival to surgery(42.7 h vs 32.5 h;P<0.0001)were all significantly longer in patients who presented to the hospital on a weekend compared to patients who presented to the hospital on a weekday.CONCLUSION This study provided insight into the“weekend effect”for geriatric hip fractures and found that day of presentation has a clinically significant impact on delivered care.

National trends in total hip arthroplasty for traumatic hip fractures:An analysis of a nationwide all-payer database

BACKGROUND Hemiarthroplasty(HA)has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures.Ideal treatment for younger,ambulatory patients is not as clear.Total hip arthroplasty(THA)has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated.AIM To examine what patient characteristics are associated with undergoing THA or HA.To determine if outcomes differ between the groups.METHODS We queried the Nationwide Inpatient Sample(NIS)for patients that underwent HA or THA for a femoral neck fracture between 2005 and 2014.The NIS comprises a large representative sample of inpatient hospitalizations in the United States.International Classifications of Disease,Ninth Edition(ICD-9)codes were used to identify patients in our sample.Demographic variables,hospital characteristics,payer status,medical comorbidities and mortality rates were compared between the two procedures.Multivariate logistic regression analysis was then performed to identify independent risk factors of treatment utilized.RESULTS Of the total 502060 patients who were treated for femoral neck fracture,51568(10.3%)underwent THA and the incidence of THA rose from 8.3%to 13.7%.Private insurance accounted for a higher percentage of THA than hemiarthroplasty.THA increased most in urban teaching hospitals relative to urban non-teaching hospitals.Mean length of stay(LOS)was longer for HA.The mean charges were less for HA,however charges decreased steadily for both groups.HA had a higher mortality rate,however,after adjusting for age and comorbidities HA was not an independent risk factor for mortality.Interestingly,private insurance was an independent predictor for treatment with THA.CONLUSION There has been an increase in the use of THA for the treatment of femoral neck fractures in the United States,most notably in urban hospitals.HA and THA are decreasing in total charges and LOS.

Higher cost of arthroplasty for hip fractures in patients transferred from outside hospitals vs primary emergency department presentation

BACKGROUND In 2016 Centers for Medicare and Medicaid Services proposed bundled payments for hip fractures to improve the quality and decrease costs of care.Patients transferred from other facilities may be imposing a financial risk on the hospitals that accept these patients.AIM To determine the costs associated with patients that either presented to the emergency department or were transferred from another hospital or skilled nursing facility(SNF)with the diagnosis of a hip fracture requiring operative intervention.METHODS A retrospective single institution review was conducted for all arthroplasty patients from 2010 to 2015.Inclusion criteria included a total or partial hip replacement for a hip fracture.Exclusion criteria included pathologic,periprosthetic,and fracture non-union.Data was collected to compare total observed costs for patients from the emergency department,patients from skilled nursing facilities,and patients from an outside hospital.RESULTS A total of 223 patients met the inclusion criteria.135(60.54%)of these patients presented primarily to the emergency department,58 patients(26.01%)were transferred from an outside hospital,and 30 patients(13.43%)were transferred from a SNF.Cost data analysis showed that outside hospital patients demonstrated significantly greater total cost for their hospitalization($43302)compared to emergency department patients($28875,P=0.000)and SNF patients($28282,P=0.000).CONCLUSION Patients transferred from an outside hospital incurred greater costs for their hospitalization than patients presenting from an emergency department or SNF.This is a strong argument for riskadjustment models when bundling payments for the care of hip fracture patients.

Comparison of the Analgesic Effects of Ultrasound Guided Supra-Inguinal Fascia Iliaca Block with Femoral Nerve Block for Surgical Fixation of Hip Fractures

Introduction: Regional anaesthesia techniques have been used for perioperative analgesia for hip fractures. The supra-inguinal approach to fascia iliaca block (FIB) can potentially provide superior analgesia compared to femoral nerve block (FNB) by blocking the obturator and lateral femoral cutaneous nerves. We aimed to evaluate the analgesic effect of single shot FIB and FNB for surgical fixation of hip fractures. Methods: After obtaining ethics approval and written, informed consent, 30 patients undergoing surgical fixation of hip fractures were recruited and randomized into 2 groups. Patients received either a single shot FIB or FNB with 0.5% Ropivacaine 30 mls, and a subarachnoid block. Pain scores were assessed pre-operatively, post-block, in recovery and at 24 hours post-operatively. Time to first analgesic, oxynorm consumption, opioid related side effects and block related complications were assessed at 24 hours. Results: There were no statistically significant difference in post-block pain scores, median (IQR) of 0 (0 - 0) versus 0 (0 - 0) at rest and 3 (2 - 6) versus 5 (2 - 6) on positioning for spinal;and 24 hour pain scores were 0 (0 - 0) versus 0 (0 - 0) at rest and 4 (2 - 5) versus 5 (2 - 6) on movement for FIB and FNB groups respectively. 5 patients from each group required post-operative opioids, post-operative opioids requirement were similar. Conclusions: Though ultrasound guided supra-inguinal FIB was more consistent in blocking the lateral femoral cutaneous nerve then a femoral nerve block, this did not translate to any difference in terms of pain scores, opioid consumption and side effects.

Perioperative mortality and morbidity of hip fractures among COVID-19 infected and non-infected patients: A systematic review and meta-analysis

Purpose:Hip fractures among elderly patients are surgical emergencies.During COVID-19 pandemic time,many such patients could not be operated at early time because of the limitation of the medical resources,the risk of infection and redirection of medical attention to a severe infective health problem.Methods:A search of electronic databases(PubMed,Medline,CINAHL,EMBASE and the Cochrane Central Register of Controlled Trials)with the keywords"COVID","COVID-19","SARS-COV-2","Corona","pandemic","hip fracture","trochanteric fracture"and"neck femur fracture"revealed 64 studies evaluating treatment of hip fracture in elderly patients during COVID-19 pandemic time.The 30-day mortality rate,inpatient mortality rate,critical care/special care need,readmission rate and complications rate in both groups were evaluated.Data were analyzed using Review Manager(RevMan)V.5.3.Results:After screening,7 studies were identified that described the mortality and morbidity in hip fractures in both COVID-19 infected(COVID-19+)and non-infected(COVID-19-)patients.There were significantly increased risks of 30-day mortality(32.23%COVID-19+deathvs.8.85%COVID-19-death)and inpatient mortality(29.33%vs.2.62%)among COVID-19+patients with odds ratio(OR)of 4.84(95%CI:3.13-7.47,p<0.001)and 15.12(95%CI:6.12-37.37,p<0.001),respectively.The COVID-19+patients needed more critical care admission(OR=5.08,95%CI:1.49-17.30,p<0.009)and they remain admitted for a longer time in hospital(mean difference=3.6,95% CI:1.74-5.45,p<0.001);but there was no difference in readmission rate between these 2 groups.The risks of overall complications(OR=17.22),development of pneumonia(OR=22.25),and acute respiratory distress syndrome/acute respiratory failure(OR=32.96)were significantly high among COVID-19+patients compared to COVID-19-patients.Conclusions:There are increased risks of the 30-day mortality,inpatient mortality and critical care admission among hip fracture patients who are COVID-19+.The chances of developing pneumonia and acute respiratory failure are more in COVID-19+patients than in COVID-19-patients.

Analgesic Effect of Combined Spinal-Epidural Anesthesia and its Effect on TNF-α and CRP Levels in Elderly Patients with Hip Fracture During Surgical Treatment

Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our hospital from January 2021 to December 2022 were selected and randomly divided into two groups,with 60 cases in the experimental group and 60 in the control group.The experimental group was given combined spinal-epidural anesthesia intervention measures,while the control group was given epidural anesthesia intervention measures.The analgesic effect,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)levels,and other observation indicators were analyzed after anesthesia intervention.Result:After the intervention,the analgesic effect and the evaluation results of the subjects in the experimental group were better than those in the control group(P<0.05);the obtained values of TNF-αand CRP levels in the experimental group were higher than those of the control group(P<0.05).Conclusion:The combined spinal-epidural anesthesia intervention demonstrated positive outcomes.The analgesic effect of patients during surgery and their inflammatory factor levels improved,which makes this intervention worthy of clinical application and promotion.

Exploring the Effect of Qi Cross-Shaped Moxibustion on the Recovery of Gastrointestinal Function after Hip Fracture in the Elderly

Objective:To explore the effect of Qi cross-shaped moxibustion on the recovery of gastrointestinal function in elderly hip fracture patients after surgery.Methods:62 elderly hip fracture surgery patients were selected as the base analysis sample,enrolled in January 2023-May 2024,and divided into an observation group(n=31)and a control group(n=31)using the digital table random draw scheme.The patients in the control group underwent conventional dietary intervention,and the patients in the observation group underwent Qi cross-shaped moxibustion intervention,comparing the gastrointestinal function recovery time and quality of life scores(PAC-QOL)of patients with constipation between the two groups.Results:The gastrointestinal function recovery time of the observation group was lower than that of the control group(P<0.05);the PAC-QOL score of the observation group was lower than that of the control group after the intervention(P<0.05).Conclusion:Qi cross-shaped moxibustion can shorten the recovery time of gastrointestinal function and improve the quality of life of elderly hip fracture patients after surgery,and it has the value of promotion and application.

Prognostic factors and predictive model for in-hospital mortality following hip fractures in the elderly

Purpose： The incidence of hip fractures is increasing within the aging population. Our objective was to identify and quantify the risk factors and develop a predictive model for the in-hospital mortality among hip fracture patients older than 65 years. Methods： This is a prospective study conducted on 331 hip fracture patients older than 65 years admitted to our hospital from 2011 to 2014. Patients＇ demographics, prehospitalization residential status, pre- fracture comorbidity data, anti-aggregant and anticoagulant medication, preoperative hemoglobin value, type of fractures, type of treatments, time to surgery, and complications were recorded. Results： The average age was 83 years, 73% female, and 57% of them sustained a femoral neck fracture. In 62.8% of patients, the number of pre-fracture baseline comorbidities was 〉2. The in-hospital mortality rate was 11.4%. In multivariate analysis, age over 90 years, congestive heart failure, asthma, rheumatologic disease, lung cancer, and not taking antiaggregant medication were independently associated with in-hospital mortality. A formula and risk stratification scoring for predicting the risk for in-hospital mortality was developed, Risk-adjustment model based on these variables had acceptable accuracy for predicting in-hospital mortality （c-statistic 0.77）. Conclusion： Advanced age, and five prefracture comorbidities have a strong association with in-hospital mortality in a hip fracture patient older than 65 years old. Our predictive model was specifically designed for the old hip fracture population. It has an accuracy similar to other risk models. The specificity, positive predictive value, and negative predictive value are high. In addition, it could discriminate a high risk patient from a low risk patient for in-hospital mortality.

Relationship between surgical time and postoperative complications in senile patients with hip fractures

Objective：To elucidate the relationship between surgical time and postoperative complications in senile patients with hip fractures, and try to find out other factors which are related to these complications.Methods： Sixty-two patients, 28 males aged from 65 to 72 years with a mean age of 76.3 years and 34 females aged from 65 to 95 years with a mean age of 78.1 years, who had undergone orthopedic surgery because of hip fractures,were enrolled in a retrospective cohort study. The surgical time and pattern, the type of fracture, preoperative comorbidities, American Society of Anesthesiologists （ASA） score and the volume of blood transfusion during operation were obtained from these patients who were followed up by telephone calls for postoperative complications.All the patients were followed up at least for 1 year and were divided into subgroups according to their clinical characteristics and the results were analyzed by the Statistical Analysis System software.Results：There was no significant difference in the morbidity of postoperative eomplications with the gender,age,surgical time and pattern,or ASA score. There was significant difference in the morbidity of postoperative complications related to preoperative comorbidities and the volume of blood transfusion. There was a significant causality between preoperative comorbidities and postoperative complications. The morbidity of postoperative complications was 1.651 times higher in patients with preoperative comorbidities than those without.Conclusions：There is no relationship between the surgical time and postoperative complications in senile patients who received surgery for hip fracture within 1 year.No correlation is found between the postoperative complications and gender,age,type of fracture, surgical pattern,ASA score and the volume of blood transfusion. Preoperative comorbidities are an independent predictor for postoperative complications.

Effects of Xinkeshu combined with levosimendan on perioperative heart failure in oldest-old patients with hip fractures

OBJECTIVE:To investigate the clinical effects of Xinkeshu combined with levosimendan on perioperative heart failure in oldest-old patients with hip fractures.METHODS:Oldest-old patients over 80 years old with perioperative heart failure and hip fractures were randomly divided into the control and observation groups,with 50 patients in each group.All patients in both groups were treated with conventional anti-heart failure therapy and levosimendan,whereas patients in the observation group additionally received Xinkeshu tablets.Clinical manifestations;left ventricular ejection fraction(LVEF);left ventricular end-diastolic dimension(LVEDD);left ventricular end-systolic dimension(LVESD);B-type natriuretic peptide(BNP),superoxide dismutase(SOD),malondialdehyde(MDA),nitric oxide(NO),and endothelin-1(ET-1)levels;and self-rating anxiety scale(SAS)and self-rating depression scale(SDS)scores were compared between before and after treatment to evaluate the curative effects of Xinkeshu combined with levosimendan.RESULTS:After treatment,the efficacy rate was significantly higher in the observation group than in the control group.LVEF and the levels of SOD and NO were higher in the observation group than in the control group after treatment.However,LVEDD;LVESD;BNP,MDA,and ET-1 levels;and the SAS and SDS scores were lower after treatment in the observation group than in the control group.CONCLUSION:Levosimendan combined with Xinkeshu can improve cardiac function,alleviate oxidative stress,and relieve anxiety and depression in oldest-old patients with perioperative heart failure and hip fracture.

Predictors for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary nailing

The aim of our study was to determine predictive factors and requirement for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary device. Methods： Seventy-nine patients with extra capsular hip fractures treated with cephalo-medullary nailing were included in the study. Age, sex, ASA grade, timing of surgery, preoperative and postoperative haemoglobin, length of hospital stay, fracture type, number of units transfused and 30-day mortality were recorded. Results： The mean age was 82.3 years. Forty-seven patients underwent a short nail and 32 patients a long nail; 53.4% patients required blood transfusion postoperatively. Transfusion was required in 71,8% of the long nails （p 〈 0.05）, 65.8% patients above the age of 80 （p 〈 0.05）, 100% of the patients with hemoglobin below 90 g/L and 20 patients with a ASA grade of 3 （p 〈 0.05）. 78.5% patients with A2 fracture and 75% of A3 fractures needed blood transfusion （p 〉 0.05）. Length of hospital stay in non-transfusion group was 13 days and in transfusion group was 19 days （p 〈 0.05）. 55.1% operated within 36 h and 47,B% operated after 3B h of admission needed transfusion （p 〉 0.05）. Thirty-day mortality in patients needing blood transfusion was 5% and in non-transfusion group was 3.7% （p 〉 0.05）, Conclusion： Patient age, ASA grade, preoperative haemoglobin and length of nail are reliable predictors for perioperative blood transfusion in extra capsular hip fractures in elderly patients treated with cephalo-medullary nailing and reinforce a selective transfusion policy.

The effects of information platform-based nursing on preventing venous thromboembolism in patients with hip fractures

Purpose:Venous thromboembolism(VTE)is a major health issue among hip fracture patients.This study aimed to develop an information platform based on a mobile application and then evaluate whether information platform-based nursing could improve patient’’s drug compliance and reduce the incidence of VTE in hip fracture patients.Methods:This study retrospectively analyzed hip fracture patients who were treated with conventional prevention and intervention methods for VTE(control group)between January 2008 and November 2012,and prospectively analyzed hip fracture patients who were treated with nursing intervention based on the information platform(study group)between January 2016 and September 2017.All the patients included in the both groups were hip fracture patients who had an age over 50 years,treated with surgery,and hospitalized≥48 h.Patients were excluded if they admitted to hospital due to old fractures,had a severe bleeding after 72 h of admission,diagnosed with any type of VTE,or refused to participate in the study.The information platform was divided into medical,nursing,and patient interface.Based on the information platform,medical practitioners and nurses could perform risk assessments,monitoring management and early warnings,preventions and treatments,health educations,follow-up,and other aspects of nursing interventions for patients.This study compared essential characteristics,drug compliance,VTE occurrence,and mean length of hospitalization between the two groups.Besides,a subgroup analysis was performed in the study group according to different drug compliances.SPSS 18.0 software(IBM Corp.,NY,and USA)was used for statistical analysis.Results:Altogether 1177 patients were included in the control group,and 491 patients in the study group.Regarding baseline data,patients in the study group had more morbidities than those in the control group(p<0.05).The difference of drug compliance between the two groups was statistically significant(p<0.001):761(64.7%)of the patients in the control group and only 30(6.1%)patients in the study group had poor drug compliance.In terms of VTE,10.7%patients(126/1177)in the control group had VTE,and the rate in the study group was 7.1%(35/491),showing a statistically significant difference(p=0.02).Moreover,the average length of hospitalization in the study group was also significantly lower than that in the control group(10.4 daysvs.13.7 days,p<0.001).Subgroup analyses of the study group showed that the incidence of VTE in patients with poor,partial,and good compliances were 56.7%(17/30),5.8%(10/171),and 2.8%(8/290),respectively,revealing a significantly huge difference(p<0.001).Conclusions:Poor drug compliance leads to higher VTE occurrence.The information platform-based nursing can effectively improve the compliance of hip fracture patients and thus considerably reduce the incidence of VTE.The mobile application may be an effective tool to prevent VTE in hip fracture patients.

Medium-term mortality after hip fractures and COVID-19:A prospective multicentre UK study

Purpose:The COVID-19 pandemic has caused 1.4 million deaths globally and is associated with a 3-4 times increase in 30-day mortality after a fragility hip fracture with concurrent COVID-19 infection.Typically,death from COVID-19 infection occurs between 15 and 22 days after the onset of symptoms,but this period can extend up to 8 weeks.This study aimed to assess the impact of concurrent COVID-19 infection on 120-day mortality after a fragility hip fracture.Methods:A multi-centre prospective study across 10 hospitals treating 8%of the annual burden of hip fractures in England between 1st March and 30th April,2020 was performed.Patients whose surgical treatment was payable through the National Health Service Best Practice Tariff mechanism for"fragility hip fractures"were included in the study.Patients'120-day mortality was assessed relative to their perioperative COVID-19 status.Statistical analysis was performed using SPSS version 27.Results:A total of 746 patients were included in this study,of which 87(11.7%)were COVID-19 positive.Mortality rates at 30-and 120-day were significantly higher for COVID-19 positive patients relative to COVID-19 negative patients(p<0.001).However,mortality rates between 31 and 120-day were not significantly different(p=0.107),16.1%and 9.4%respectively for COVID-19 positive and negative patients,odds ratio 1.855(95%CI 0.865-3.978).Conclusion:Hip fracture patients with concurrent COVID-19 infection,provided that they are alive at day-31 after injury,have no significant difference in 120-day mortality.Despite the growing awareness and concern of "long-COVID"and its widespread prevalence,this does not appear to increase mediumterm mortality rates after a hip fracture.